Methods of Suppressing Rheumatoid Arthritis Using An Anti-IL-6 Antibody

ABSTRACT

Anti-IL-6 antibodies and antirheumatics are useful to treat and suppress IL-6 related conditions, such as rheumatoid arthritis.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.15/132,851, filed 19 Apr. 2016, currently allowed, which is a divisionalof U.S. application Ser. No. 14/096,596, filed 4 Dec. 2013, now U.S.Pat. No. 9,340,613, which is a divisional of U.S. application Ser. No.13/524,684, filed 15 Jun. 2012, now U.S. Pat. No. 8,623,362, which is adivisional of U.S. application Ser. No. 13/283,177, filed 27 Oct. 2011,currently U.S. Pat. No. 8,226,611, which is a divisional of U.S.application Ser. No. 12/901,200, filed 8 Oct. 2010, now U.S. Pat. No.8,067,003, which is a divisional of U.S. application Ser. No.12/470,753, filed 22 May 2009, now U.S. Pat. No. 7,833,755, which is adivisional of U.S. patent application Ser. No. 11/413,561, filed 28 Apr.2006, now U.S. Pat. Reissue No. 43,672, in a reissue application underU.S. application Ser. No. 13/178,998, filed 8 Jul. 2011, which claimspriority to U.S. Provisional Application Nos. 60/676,498, filed 29 Apr.2005 and 60/677,319, filed 3 May 2005. The entire contents of each ofthe aforesaid applications are incorporated herein by reference in theirentireties.

FIELD OF THE INVENTION

The present invention relates to antibodies, including specifiedportions or variants, specific for at least one IL-6 protein or fragmentthereof, as well as anti-idiotype antibodies, and nucleic acids encodingsuch anti-IL-6 antibodies, complementary nucleic acids, vectors, hostcells, and methods of making and using thereof, including therapeuticformulations, administration and devices.

BACKGROUND OF THE INVENTION

IL-6 is a pleiotropic proinflammatory cytokine produced and secreted bya wide variety of cell types most notably antigen presenting cells, Tand B cells. IL-6 is involved in such diverse activities as B cellgrowth and differentiation, T cell activation, hematopoiesis, osteoclastactivation, keratinocyte growth, neuronal growth and hepatocyteactivation. IL-6 binds to transmembrane or soluble IL-6R and signalsthrough gp130, which is shared by several other cytokines.

IL-6 plays an important role in B cell abnormalities as demonstrated insystemic lupus erythematosus, multiple myeloma and lymphoproliferativedisorders. Similarly, IL-6 is also implicated in the pathogenesis ofautoimmune and inflammatory diseases such as rheumatoid arthritis andosteoarthritis. Recently, indirect evidence suggests an associationbetween IL-6 and chronic obstructive pulmonary disease and insulinresistance in type 2 diabetes. IL-6 has both pro-inflammatory andanti-inflammatory effects in the immune system, indicating that thiscytokine likely plays a central role in regulating the physiologicalresponse to disease. Therefore, targeting IL-6 can potentially providetherapeutic benefit in a variety of disease areas.

An increase in the production of IL-6 has been observed in a number ofdiseases including: Alzheimer's disease, autoimmune diseases, such asrheumatoid arthritis, inflammation, myocardial infarction, Paget'sdisease, osteoporosis, solid tumors (renal cell carcinoma), prostaticand bladder cancers, neurological cancers, and B-cell malignancies(e.g., Casteleman's disease, certain lymphomas, chronic lymphocyticleukemia, and multiple myeloma). Research has indicated that IL-6 islinked to the pathogenesis of many of these diseases, particularly,cancer and, therefore, blocking IL-6 should translate into clinicalbenefits.

Murine, chimeric, and other non-human anti-IL-6 antibodies have beendeveloped; however, they may be limited in their potency, effectiveness,may often trigger an unacceptable immune response (i.e., immunogenicity)and/or require a high dosage (See, Trikha et al., Clin. Can. Res. 9,4653-4665, October 2003, herein incorporated by reference). For example,antibodies containing non-human portions often give rise to an immuneresponse in humans. Accordingly, repeated antibody administration isunsuitable as therapy and immune complex mediated clearance ofantibodies from circulation can reduce the potency/effectiveness of theantibody. Serum sickness and anaphylaxis are two exemplary conditionsthat may be caused by repeat administration of antibodies havingnon-human portions. In this regard, an anti-IL-6 antibody with lesspotential for immunogenicity, i.e., more tolerable in humans, and thatis more potent such that it requires a smaller dosage as compared topreviously used anti-IL-6 antibodies is needed.

SUMMARY OF THE INVENTION

The present invention provides isolated human engineered, anti-IL-6antibodies (also referred to as IL-6 antibodies), immunoglobulins,fragments, cleavage products and other specified portions and variantsthereof, as well as anti-IL-6 antibody compositions, IL-6 anti-idiotypeantibody, encoding or complementary nucleic acids, vectors, host cells,compositions, formulations, devices, transgenic animals, transgenicplants, and methods of making and using them.

The present invention provides, in one aspect, isolated nucleic acidmolecules comprising, complementary, or hybridizing to, a polynucleotideencoding specific anti-IL-6 antibodies or anti-idiotype antibodies,comprising at least one specified sequence, domain, portion or variantthereof. The present invention further provides recombinant vectorscomprising said anti-IL-6 antibody nucleic acid molecules, host cellscontaining such nucleic acids and/or recombinant vectors, as well asmethods of making and/or using such antibody nucleic acids, vectorsand/or host cells.

The present invention also provides at least one method for expressingat least one anti-IL-6 antibody, or IL-6 anti-idiotype antibody, in ahost cell, comprising culturing a host cell as described herein underconditions wherein at least one anti-IL-6 antibody is expressed indetectable and/or recoverable amounts.

The present invention also provides at least one composition comprising(a) an isolated anti-IL-6 antibody encoding nucleic acid and/or antibodyas described herein; and (b) a suitable and/or pharmaceuticallyacceptable carrier or diluent.

The present invention further provides at least one anti-IL-6 antibodymethod or composition, for administering a therapeutically effectiveamount to modulate or treat at least one IL-6 related condition in acell, tissue, organ, animal or patient and/or, prior to, subsequent to,or during a related condition, as known in the art and/or as describedherein.

The present invention also provides at least one composition, deviceand/or method of delivery of a therapeutically or prophylacticallyeffective amount of at least one anti-IL-6 antibody, according to thepresent invention.

The present invention further provides at least one anti-IL-6 antibodymethod or composition, for diagnosing at least one IL-6 relatedcondition in a cell, tissue, organ, animal or patient and/or, prior to,subsequent to, or during a related condition, as known in the art and/oras described herein.

The present invention also provides at least one composition, deviceand/or method of delivery for diagnosing of at least one anti-IL-6antibody, according to the present invention.

Also provided is a medical device, comprising at least one isolatedmammalian anti-IL-6 antibody of the invention, wherein the device issuitable for contacting or administering the at least one anti-IL-6antibody, IL-6 anti-idiotypic antibody, nucleic acid molecule, compound,protein, and/or composition.

Also provided is an article of manufacture for human pharmaceutical ordiagnostic use, comprising packaging material and a container comprisinga solution or a lyophilized form of at least one isolated anti-IL-6antibody of the present invention. The article of manufacture canoptionally have the container as a component of a delivery device orsystem.

The present invention further provides any invention described herein.

DESCRIPTION OF THE FIGURES

FIG. 1 shows the binding of human engineered and chimeric anti-IL-6antibody to IL-6/IL-6R complex.

FIG. 2 shows the binding epitope for the human engineered anti-IL-6antibody of the present invention.

FIG. 3 demonstrates that human engineered anti-IL-6 antibody inhibitsIL-6 stimulated MCP-1 secretion from U937 cells as measured by ELISA.

FIG. 4 shows that the human engineered anti-IL-6 antibody inhibits IL-6and IL-1β stimulated SAA secretion from HepG2 cells as measured byELISA.

FIGS. 5A and 5B show that human engineered anti-IL-6 antibody blockedIL-6-mediated stat3 phosphorylation as measured by Western Blot analysisshown through gel electrophoresis.

FIG. 6 shows the inhibition by human engineered and chimeric anti-IL-6antibody of human IL-6-induced SAA production in Balb/C mice.

FIG. 7 shows the inhibition of anti-dsDNA autoantibody production byanti-IL-6 mAb in NZB/W F1 mice.

FIG. 8A shows the effect of IL-6 in the presence and absence of humanengineered anti-IL-6 antibody on insulin induced Akt phosphorylation.

FIG. 8B shows a western blot analysis of the effect of IL-6 in thepresence and absence of human engineered anti-IL-6 antibody on insulininduced Akt phosphorylation.

FIG. 9 shows the results of the ELISA binding assay described in Example3.

FIG. 10 shows the results of an anti-proliferation assay using the IL-6dependent cell line described in Example 3.

FIG. 11A shows PI3 kinase activation in rat hepatocytes treated withinsulin, IL-6 protein, and anti-IL-6 antibody.

FIG. 11B shows the control for the study of PI3 kinase activation in rathepatocytes.

FIG. 12A shows the effect of IL-6 on signaling in rat hepatocytes withrespect to the insulin-induced phosphorylation of IR.

FIG. 12B shows the effect of IL-6 on signaling in rat hepatocytes withrespect to the insulin-induced phosphorylation of Akt.

FIG. 13A shows the glucose level in DIO mice after treatment withanti-IL-6 antibody.

FIG. 13B shows the insulin level in DIO mice after treatment withanti-IL-6 antibody.

FIG. 13C shows the homeostatic model assessment (HOMA) index in DIO miceafter treatment with anti-IL-6 antibody.

FIGS. 14A-F show the levels of lipids before and after treatment withanti-IL-6 antibody.

FIG. 15 shows the treatment schedule of mice with anti IL-6 mAb for anintraperitoneal glucose tolerance test (ipGTT).

DESCRIPTION OF THE INVENTION

The present invention provides isolated, recombinant and/or syntheticanti-IL-6 human engineered antibodies and IL-6 anti-idiotype antibodiesthereto, as well as compositions and encoding nucleic acid moleculescomprising at least one polynucleotide encoding at least one anti-IL-6antibody or anti-idiotype antibody. The present invention furtherincludes, but is not limited to, methods of making and using suchnucleic acids and antibodies and anti-idiotype antibodies, includingdiagnostic and therapeutic compositions, methods and devices.

As used herein, an “anti-IL-6 antibody,” “IL-6 antibody,” “anti-IL-6antibody portion,” or “anti-IL-6 antibody fragment” and/or “anti-IL-6antibody variant” and the like include any protein or peptide containingmolecule that comprises at least a portion of an immunoglobulinmolecule, such as but not limited to, at least one complementaritydetermining region (CDR) of a heavy or light chain or a ligand bindingportion thereof, a heavy chain or light chain variable region, a heavychain or light chain constant region, a framework region, or any portionthereof, or at least one portion of an IL-6 receptor or binding protein,which can be incorporated into an antibody of the present invention.Such antibody optionally further affects a specific ligand, such as butnot limited to, where such antibody modulates, decreases, increases,antagonizes, agonizes, mitigates, alleviates, blocks, inhibits,abrogates and/or interferes with at least one IL-6 activity or binding,or with IL-6 receptor activity or binding, in vitro, in situ and/or invivo. As a non-limiting example, a suitable anti-IL-6 antibody,specified portion or variant of the present invention can bind at leastone IL-6 molecule, or specified portions, variants or domains thereof. Asuitable anti-IL-6 antibody, specified portion, or variant can alsooptionally affect at least one of IL-6 activity or function, such as butnot limited to, RNA, DNA or protein synthesis, IL-6 release, IL-6receptor signaling, membrane IL-6 cleavage, IL-6 activity, IL-6production and/or synthesis.

The term “antibody” is further intended to encompass antibodies,digestion fragments, specified portions and variants thereof, includingantibody mimetics or comprising portions of antibodies that mimic thestructure and/or function of an antibody or specified fragment orportion thereof, including single chain antibodies and fragmentsthereof. Functional fragments include antigen-binding fragments thatbind to a mammalian IL-6. For example, antibody fragments capable ofbinding to IL-6 or portions thereof, including, but not limited to, Fab(e.g., by papain digestion), Fab′ (e.g., by pepsin digestion and partialreduction) and F(ab′)2 (e.g., by pepsin digestion), facb (e.g., byplasmin digestion), pFc′ (e.g., by pepsin or plasmin digestion), Fd(e.g., by pepsin digestion, partial reduction and reaggregation), Fv orscFv (e.g., by molecular biology techniques) fragments, are encompassedby the invention (see, e.g., Colligan, Immunology, supra).

Such fragments can be produced by enzymatic cleavage, synthetic orrecombinant techniques, as known in the art and/or as described herein.Antibodies can also be produced in a variety of truncated forms usingantibody genes in which one or more stop codons have been introducedupstream of the natural stop site. For example, a combination geneencoding a F(ab′)2 heavy chain portion can be designed to include DNAsequences encoding the CH₁ domain and/or hinge region of the heavychain. The various portions of antibodies can be joined togetherchemically by conventional techniques, or can be prepared as acontiguous protein using genetic engineering techniques.

As used herein, the term “human engineered antibody” is an antibody withat least fully human frameworks and constant regions (C_(L), C_(H)domains (e.g., C_(H)1, C_(H)2, C_(H)3), and hinge), and CDRs derivedfrom antigen binding antibodies. Fully human frameworks compriseframeworks that correspond to human germline sequences as well assequences with somatic mutations. CDRs may be derived from one or moreCDRs that bind to IL-6 in the context of any antibody framework. Forexample, the CDRs of the human engineered antibody of the presentinvention may be derived from CDRs that bind IL-6 in the context of amouse antibody framework and then are engineered to bind IL-6 in thecontext of a fully human framework. Often, the human engineered antibodyis substantially non-immunogenic in humans.

Similarly, antibodies designated primate (monkey, baboon, chimpanzee,etc.), rodent (mouse, rat, rabbit, guinea pig, hamster, and the like)and other mammals designate such species, sub-genus, genus, sub-family,and family specific antibodies. Further, chimeric antibodies can includeany combination of the above. Such changes or variations optionally andpreferably retain or reduce the immunogenicity in humans or otherspecies relative to non-modified antibodies. Thus, a human engineeredantibody is distinct from a chimeric or humanized antibody.

It is pointed out that a human engineered antibody can be produced by anon-human animal or prokaryotic or eukaryotic cell that is capable ofexpressing functionally rearranged human or human engineeredimmunoglobulin (e.g., heavy chain and/or light chain) genes. Further,when a human engineered antibody is a single chain antibody, it cancomprise a linker peptide that is not found in native human antibodies.For example, an F_(V) can comprise a linker peptide, such as two toabout eight glycine or other amino acid residues, which connects thevariable region of the heavy chain and the variable region of the lightchain. Such linker peptides are considered to be of human origin.

Bispecific, heterospecific, heteroconjugate or similar antibodies canalso be used that are monoclonal, preferably, human, human engineered,or humanized, antibodies that have binding specificities for at leasttwo different antigens. In the present case, one of the bindingspecificities is for at least one IL-6 protein, the other one is for anyother antigen. Methods for making bispecific antibodies are known in theart. Traditionally, the recombinant production of bispecific antibodiesis based on the co-expression of two immunoglobulin heavy chain-lightchain pairs, where the two heavy chains have different specificities(Milstein and Cuello, Nature 305:537 (1983)). Because of the randomassortment of immunoglobulin heavy and light chains, these hybridomas(quadromas) produce a potential mixture of 10 different antibodymolecules, of which only one has the correct bispecific structure. Thepurification of the correct molecule is usually done by affinitychromatography steps. Similar procedures are disclosed, e.g., in WO93/08829, U.S. Pat. Nos. 6,210,668, 6,193,967, 6,132,992, 6,106,833,6,060,285, 6,037,453, 6,010,902, 5,989,530,5,959,084,5959083,5932448,5833985,5821333,5807706,5643759,5601819,5582996, 5496549, 4676980, WO 91/00360, WO 92/00373, EP 03089,Traunecker et al., EMBO J. 10:3655 (1991), Suresh et al., Methods inEnzymology 121:210 (1986), each entirely incorporated herein byreference.

Anti-IL-6 antibodies useful in the methods and compositions of thepresent invention can optionally be characterized by high affinitybinding to IL-6 and, optionally and preferably, as having low toxicity.In particular, an antibody, specified fragment or variant of theinvention, where the individual components, such as the variable region,constant region and framework, individually and/or collectively,optionally and preferably possess low immunogenicity, is useful in thepresent invention. The antibodies that can be used in the invention areoptionally characterized by their ability to treat patients for extendedperiods with measurable alleviation of symptoms and low and/oracceptable toxicity. Low or acceptable immunogenicity and/or highaffinity, as well as other suitable properties, can contribute to thetherapeutic results achieved. “Low immunogenicity” is defined herein asthe incidence of titrable levels of antibodies to the anti-IL-6 antibodyin patients treated with anti-IL-6 antibody as occurring in less than25% of patients treated, preferably, in less than 10% of patientstreated with the recommended dose for the recommended course of therapyduring the treatment period.

The isolated nucleic acids of the present invention can be used forproduction of at least one anti-IL-6 antibody or specified variantthereof, which can be used to measure or effect in an cell, tissue,organ or animal (including mammals and humans), to diagnose, monitor,modulate, treat, alleviate, help prevent the incidence of, or reduce thesymptoms of, at least one IL-6 condition, selected from, but not limitedto, at least one of an immune disorder or disease, a cardiovasculardisorder or disease, an infectious, malignant, and/or neurologicdisorder or disease, or other known or specified IL-6 related condition.

Such a method can comprise administering an effective amount of acomposition or a pharmaceutical composition comprising at least oneanti-IL-6 antibody to a cell, tissue, organ, animal or patient in needof such modulation, treatment, alleviation, prevention, or reduction insymptoms, effects or mechanisms. The effective amount can comprise anamount of about 0.001 to 500 mg/kg per single (e.g., bolus), multiple orcontinuous administration, or to achieve a serum concentration of0.01-5000 μg/ml serum concentration per single, multiple, or continuousadministration, or any effective range or value therein, as done anddetermined using known methods, as described herein or known in therelevant arts.

Antibodies of the Present Invention—Production and Generation

At least one anti-IL-6 antibody of the present invention can beoptionally produced by a cell line, a mixed cell line, an immortalizedcell or clonal population of immortalized cells, as well known in theart. See, e.g., Ausubel, et al., ed., Current Protocols in MolecularBiology, John Wiley & Sons, Inc., NY, N.Y. (1987-2001); Sambrook, etal., Molecular Cloning: A Laboratory Manual, 2^(nd) Edition, Cold SpringHarbor, N.Y. (1989); Harlow and Lane, Antibodies, a Laboratory Manual,Cold Spring Harbor, N.Y. (1989); Colligan, et al., eds., CurrentProtocols in Immunology, John Wiley & Sons, Inc., NY (1994-2001);Colligan et al., Current Protocols in Protein Science, John Wiley &Sons, NY, N.Y., (1997-2001).

Human engineered antibodies that are specific for human IL-6 proteins orfragments thereof can be raised against an appropriate immunogenicantigen, such as an isolated IL-6 protein and/or a portion thereof(including synthetic molecules, such as synthetic peptides). Otherspecific or general mammalian antibodies can be similarly raised.Preparation of immunogenic antigens, and monoclonal antibody productioncan be performed using any suitable technique.

In one approach, a hybridoma is produced by fusing a suitable immortalcell line (e.g., a myeloma cell line, such as, but not limited to,Sp2/0, Sp2/0-AG14, NSO, NS1, NS2, AE-1, L.5, L243, P3X63Ag8.653, Sp2SA3, Sp2 MAI, Sp2 SS1, Sp2 SA5, U937, MLA 144, ACT IV, MOLT4, DA-1,JURKAT, WEHI, K-562, COS, RAJI, NIH 3T3, HL-60, MLA 144, NAMALWA, NEURO2A, or the like, or heteromylomas, fusion products thereof, or any cellor fusion cell derived therefrom, or any other suitable cell line asknown in the art) (see, e.g., www.atcc.org, www.lifetech.com., and thelike), with antibody producing cells, such as, but not limited to,isolated or cloned spleen, peripheral blood, lymph, tonsil, or otherimmune or B cell containing cells, or any other cells expressing heavyor light chain constant or variable or framework or CDR sequences,either as endogenous or heterologous nucleic acid, as recombinant orendogenous, viral, bacterial, algal, prokaryotic, amphibian, insect,reptilian, fish, mammalian, rodent, equine, ovine, goat, sheep, primate,eukaryotic, genomic DNA, cDNA, rDNA, mitochondrial DNA or RNA,chloroplast DNA or RNA, hnRNA, mRNA, tRNA, single, double or triplestranded, hybridized, and the like or any combination thereof. See,e.g., Ausubel, supra, and Colligan, Immunology, supra, chapter 2,entirely incorporated herein by reference.

Antibody producing cells can also be obtained from the peripheral bloodor, preferably, the spleen or lymph nodes, of humans or other suitableanimals that have been immunized with the antigen of interest. Any othersuitable host cell can also be used for expressing heterologous orendogenous nucleic acid encoding an antibody, specified fragment orvariant thereof, of the present invention. The fused cells (hybridomas)or recombinant cells can be isolated using selective culture conditionsor other suitable known methods, and cloned by limiting dilution or cellsorting, or other known methods. Cells which produce antibodies with thedesired specificity can be selected by a suitable assay (e.g., ELISA).

Methods for engineering or humanizing non-human or human antibodies canalso be used and are well known in the art. A humanized or engineeredantibody may have one or more amino acid residues from a source that isnon-human, e.g., but not limited to, mouse, rat, rabbit, non-humanprimate or other mammal. These non-human amino acid residues arereplaced by residues that are often referred to as “import” residues,which are typically taken from an “import” variable, constant or otherdomain of a known human sequence.

Known human Ig sequences are disclosed, e.g.,www.ncbi.nlm.nih.gov/entrez/query.fcgi; www.ncbi.nih.gov/igblast;www.atcc.org/phage/hdb.html; www.mrc-cpe.cam.ac.uk/ALIGNMENTS.php;www.kabatdatabase.com/top.html; ftp. ncbi.nih.gov/repository/kabat;www.sciquest.com; www.abcam.com;www.antibodyresource.com/onlinecomp.html;www.public.iastate.edu/˜pedro/research_tools.html;www.whfreeman.com/immunology/CH05/kuby05.htm;www.hhmi.org/grants/lectures/1996/vlab;www.path.cam.ac.uk/˜mrc7/mikeimages.html;mcb.harvard.edu/BioLinks/Immunology.html; www.immunologylink.com;pathbox. wustl.edu/˜hcenter/index.html; www.appliedbiosystems.com;www.nal.usda.gov/awic/pubs/antibody;www.m.ehime-u.acjp/˜yasuhito/Elisa.html; www.biodesign.com;www.cancerresearchuk.org; www.biotech.ufl.edu; www.isac-net.org; baserv.uci.kun.nl/˜jraats/linksl.html; www.recab.uni-hd.de/immuno.bme.nwu.edu;www.mrc-cpe.cam.ac.uk; www.ibt.unam.mx/vir/V_mice.html;http://www.bioinforg.uk/abs; antibody.bath.ac.uk; www.unizh.ch;www.cryst.bbk.ac.uk/˜ubcg07s; www.nimr.mrc.ac.uk/CC/ccaewg/ccaewg.html;www.path.cam.ac.uk/˜mrc7/humanisation/TAHHP.html;www.ibt.unam.mx/viestructure/stat_aim.html;www.biosci.missouri.edu/smithgp/index.html; www.jerini.de; Kabat et al.,Sequences of Proteins of Immunological Interest, U.S. Dept. Health(1983), each entirely incorporated herein by reference.

Such imported sequences can be used to reduce immunogenicity or reduce,enhance or modify binding, affinity, on-rate, off-rate, avidity,specificity, half-life, or any other suitable characteristic, as knownin the art. In general, the CDR residues are directly and mostsubstantially involved in influencing antigen binding. Accordingly, partor all of the non-human or human CDR sequences are maintained while thenon-human sequences of the variable and constant regions may be replacedwith human or other amino acids.

Antibodies can also optionally be humanized or engineered or humanantibodies engineered with retention of high affinity for the antigenand other favorable biological properties. To achieve this goal,humanized (or human) or engineered antibodies can be optionally preparedby a process of analysis of the parental sequences and variousconceptual humanized and engineered products using three-dimensionalmodels of the parental, engineered, and humanized sequences.Three-dimensional immunoglobulin models are commonly available and arefamiliar to those skilled in the art. Computer programs are availablewhich illustrate and display probable three-dimensional conformationalstructures of selected candidate immunoglobulin sequences. Inspection ofthese displays permits analysis of the likely role of the residues inthe functioning of the candidate immunoglobulin sequence, i.e., theanalysis of residues that influence the ability of the candidateimmunoglobulin to bind its antigen. In this way, framework (FR) residuescan be selected and combined from the consensus and import sequences sothat the desired antibody characteristic, such as increased affinity forthe target antigen(s), is achieved.

In addition, the human engineered IL-6 antibody of the present inventionmay comprise a human germline light chain framework. In particularembodiments, the light chain germline sequence is selected from human VKsequences including, but not limited to, A1, A10, A11, A14, A17, A18,A19, A2, A20, A23, A26, A27, A3, A30, A5, A7, B2, B3, L1, L10, L11, L12,L14, L15, L16, L18, L19, L2, L20, L22, L23, L24, L25, L4/18a, L5, L6,L8, L9, O1, O11, O12, O14, O18, O2, O4, and O8. In certain embodiments,this light chain human germline framework is selected from V1-11, V1-13,V1-16, V1-17, V1-18, V1-19, V1-2, V1-20, V1-22, V1-3, V1-4, V1-5, V1-7,V1-9, V2-1, V2-11, V2-13, V2-14, V2-15, V2-17, V2-19, V2-6, V2-7, V2-8,V3-2, V3-3, V3-4, V4-1, V4-2, V4-3, V4-4, V4-6, V5-1, V5-2, V5-4, andV5-6. See PCT WO 2005/005604 for a description of the different germlinesequences.

In other embodiments, the human engineered IL-6 antibody of the presentinvention may comprise a human germline heavy chain framework. Inparticular embodiments, this heavy chain human germline framework isselected from VH1-18, VH1-2, VH1-24, VH1-3, VH1-45, VH1-46, VH1-58,VH1-69, VH1-8, VH2-26, VH2-5, VH2-70, VH3-11, VH3-13, VH3-15, VH3-16,VH3-20, VH3-21, VH3-23, VH3-30, VH3-33, VH3-35, VH3-38, VH3-43, VH3-48,VH3-49, VH3-53, VH3-64, VH3-66, VH3-7, VH3-72, VH3-73, VH3-74, VH3-9,VH4-28, VH4-31, VH4-34, VH4-39, VH4-4, VH4-59, VH4-61, VH5-51, VH6-1,and VH7-81. See PCT WO 2005/005604 for a description of the differentgermline sequences.

In particular embodiments, the light chain variable region and/or heavychain variable region comprises a framework region or at least a portionof a framework region (e.g., containing 2 or 3 subregions, such as FR2and FR3). In certain embodiments, at least FRL1, FRL2, FRL3, or FRL4 isfully human. In other embodiments, at least FRH1, FRH2, FRH3, or FRH4 isfully human. In some embodiments, at least FRL1, FRL2, FRL3, or FRL4 isa germline sequence (e.g., human germline) or comprises human consensussequences for the particular framework (readily available at the sourcesof known human Ig sequences described above). In other embodiments, atleast FRH1, FRH2, FRH3, or FRH4 is a germline sequence (e.g., humangermline) or comprises human consensus sequences for the particularframework. In preferred embodiments, the framework region is a humanframework region (e.g., the human framework regions shown below inTables 13 and 14). In some embodiments, the framework region comprisesSEQ ID NOS: 105, 106, 107, 108, 109, 110, 111, 112, or combinationsthereof.

Humanization or engineering of antibodies of the present invention canbe performed using any known method, such as but not limited to thosedescribed in, Winter (Jones et al., Nature 321:522 (1986); Riechmann etal., Nature 332:323 (1988); Verhoeyen et al., Science 239:1534 (1988)),Sims et al., J. Immunol. 151: 2296 (1993); Chothia and Lesk, J. Mol.Biol. 196:901 (1987), Carter et al., Proc. Natl. Acad. Sci. U.S.A.89:4285 (1992); Presta et al., J. Immunol. 151:2623 (1993), U.S. Pat.Nos. 5,723,323, 5,976,862, 5,824,514, 5,817,483, 5,814,476, 5,763,192,5,723,323, 5,766886, 5,714,352, 6,204,023, 6,180,370, 5,693,762,5,530,101, 5,585,089, 5,225,539; 4,816,567, PCT/: US98/16280,US96/18978, US91/09630, US91/05939, US94/01234, GB89/01334, GB91/01134,GB92/01755; WO90/14443, WO90/14424, WO90/14430, EP 229246, each entirelyincorporated herein by reference, included references cited therein.

In certain embodiments, the antibody comprises an altered (e.g.,mutated) Fc region. For example, in some embodiments, the Fc region hasbeen altered to reduce or enhance the effector functions of theantibody. In some embodiments, the Fc region is an isotype selected fromIgM, IgA, IgG, IgE, or other isotype.

Alternatively or additionally, it may be useful to combine amino acidmodifications with one or more further amino acid modifications thatalter C1q binding and/or the complement dependent cytotoxicity (CDC)function of the Fc region of an IL-6 binding molecule. The startingpolypeptide of particular interest may be one that binds to C1q anddisplays complement dependent cytotoxicity. Polypeptides withpre-existing C1q binding activity, optionally further having the abilityto mediate CDC may be modified such that one or both of these activitiesare enhanced. Amino acid modifications that alter C1q and/or modify itscomplement dependent cytotoxicity function are described, for example,in WO0042072, which is hereby incorporated by reference.

As disclosed above, one can design an Fc region of the human engineeredIL-6 antibody of the present invention with altered effector function,e.g., by modifying C1q binding and/or FcγR binding and thereby changingCDC activity and/or ADCC activity. “Effector functions” are responsiblefor activating or diminishing a biological activity (e.g., in asubject). Examples of effector functions include, but are not limitedto: C1q binding; complement dependent cytotoxicity (CDC); Fc receptorbinding; antibody-dependent cell-mediated cytotoxicity (ADCC);phagocytosis; down regulation of cell surface receptors (e.g., B cellreceptor; BCR), etc. Such effector functions may require the Fc regionto be combined with a binding domain (e.g., an antibody variable domain)and can be assessed using various assays (e.g., Fc binding assays, ADCCassays, CDC assays, etc.).

For example, one can generate a variant Fc region of the humanengineered IL-6 antibody with improved C1q binding and improved FcγRIIIbinding (e.g., having both improved ADCC activity and improved CDCactivity). Alternatively, if it is desired that effector function bereduced or ablated, a variant Fc region can be engineered with reducedCDC activity and/or reduced ADCC activity. In other embodiments, onlyone of these activities may be increased, and, optionally, also theother activity reduced (e.g., to generate an Fc region variant withimproved ADCC activity, but reduced CDC activity and vice versa).

Fc mutations can also be introduced in engineer to alter theirinteraction with the neonatal Fc receptor (FcRn) and improve theirpharmacokinetic properties. A collection of human Fc variants withimproved binding to the FcRn have been described (Shields et al.,(2001). High resolution mapping of the binding site on human IgG1 forFcγRI, FcγRII, FcγRIII, and FcRn and design of IgG1 variants withimproved binding to the FcγR, J. Biol. Chem. 276:6591-6604).

Another type of amino acid substitution serves to alter theglycosylation pattern of the Fc region of the human engineered IL-6antibody. Glycosylation of an Fc region is typically either N-linked orO-linked. N-linked refers to the attachment of the carbohydrate moietyto the side chain of an asparagine residue. O-linked glycosylationrefers to the attachment of one of the sugars N-aceylgalactosamine,galactose, or xylose to a hydroxyamino acid, most commonly serine orthreonine, although 5-hydroxyproline or 5-hydroxylysine may also beused. The recognition sequences for enzymatic attachment of thecarbohydrate moiety to the asparagine side chain peptide sequences areasparagine-X-serine and asparagine-X-threonine, where X is any aminoacid except proline. Thus, the presence of either of these peptidesequences in a polypeptide creates a potential glycosylation site.

The glycosylation pattern may be altered, for example, by deleting oneor more glycosylation site(s) found in the polypeptide, and/or addingone or more glycosylation site(s) that are not present in thepolypeptide. Addition of glycosylation sites to the Fc region of a humanengineered IL-6 antibody is conveniently accomplished by altering theamino acid sequence such that it contains one or more of theabove-described tripeptide sequences (for N-linked glycosylation sites).An exemplary glycosylation variant has an amino acid substitution ofresidue Asn 297 of the heavy chain. The alteration may also be made bythe addition of, or substitution by, one or more serine or threonineresidues to the sequence of the original polypeptide (for O-linkedglycosylation sites). Additionally, a change of Asn 297 to Ala canremove one of the glycosylation sites.

In certain embodiments, the human engineered IL-6 antibody of thepresent invention is expressed in cells that express beta(1,4)-N-acetylglucosaminyltransferase III (GnT III), such that GnT IIIadds GlcNAc to the human engineered IL-6 antibody. Methods for producingantibodies in such a fashion are provided in WO/9954342, WO/03011878,patent publication 20030003097A1, and Umana et al., NatureBiotechnology, 17:176-180, February 1999.

A human anti-IL-6 antibody can be optionally generated by immunizationof a transgenic animal (e.g., mouse, rat, hamster, non-human primate,and the like) capable of producing a repertoire of human antibodies, asdescribed herein and/or as known in the art. Cells that produce a humananti-IL-6 antibody can be isolated from such animals and immortalizedusing suitable methods, such as the methods described herein.

Transgenic mice that can produce a repertoire of human antibodies thatbind to human antigens can be produced by known methods (e.g., but notlimited to, U.S. Pat. Nos. 5,770,428, 5,569,825, 5,545,806, 5,625,126,5,625,825, 5,633,425, 5,661,016 and 5,789,650 issued to Lonberg et al.;Jakobovits et al. WO 98/50433, Jakobovits et al. WO 98/24893, Lonberg etal. WO 98/24884, Lonberg et al. WO 97/13852, Lonberg et al. WO 94/25585,Kucherlapate et al. WO 96/34096, Kucherlapate et al. EP 0463 151 B1,Kucherlapate et al. EP 0710 719 A1, Surani et al. U.S. Pat. No.5,545,807, Bruggemann et al. WO 90/04036, Bruggemann et al. EP 0438 474B1, Lonberg et al. EP 0814 259 A2, Lonberg et al. GB 2 272 440 A,Lonberg et al. Nature 368:856-859 (1994), Taylor et al., Int. Immunol.6(4)579-591 (1994), Green et al, Nature Genetics 7:13-21 (1994), Mendezet al., Nature Genetics 15:146-156 (1997), Taylor et al., Nucleic AcidsResearch 20(23):6287-6295 (1992), Tuaillon et al., Proc Natl Acad SciUSA 90(8)3720-3724 (1993), Lonberg et al., Int Rev Immunol 13(1):65-93(1995) and Fishwald et al., Nat Biotechnol 14(7):845-851 (1996), whichare each entirely incorporated herein by reference). Generally, thesemice comprise at least one transgene comprising DNA from at least onehuman immunoglobulin locus that is functionally rearranged, or which canundergo functional rearrangement. The endogenous immunoglobulin loci insuch mice can be disrupted or deleted to eliminate the capacity of theanimal to produce antibodies encoded by endogenous genes.

Screening antibodies for specific binding to similar proteins orfragments can be conveniently achieved using peptide display libraries.This method involves the screening of large collections of peptides forindividual members having the desired function or structure. Antibodyscreening of peptide display libraries is well known in the art. Thedisplayed peptide sequences can be from 3 to 5000 or more amino acids inlength, frequently from 5-100 amino acids long, and often from about 8to 25 amino acids long. In addition to direct chemical synthetic methodsfor generating peptide libraries, several recombinant DNA methods havebeen described. One type involves the display of a peptide sequence onthe surface of a bacteriophage or cell. Each bacteriophage or cellcontains the nucleotide sequence encoding the particular displayedpeptide sequence. Such methods are described in PCT Patent PublicationNos. 91/17271, 91/18980, 91/19818, and 93/08278.

Other systems for generating libraries of peptides have aspects of bothin vitro chemical synthesis and recombinant methods. See, PCT PatentPublication Nos. 92/05258, 92/14843, and 96/19256. See also, U.S. Pat.Nos. 5,658,754; and 5,643,768. Peptide display libraries, vector, andscreening kits are commercially available from such suppliers asInvitrogen (Carlsbad, Calif.), and Cambridge Antibody Technologies(Cambridgeshire, UK). See, e.g., U.S. Pat. Nos. 4,704,692, 4,939,666,4,946,778, 5,260,203, 5,455,030, 5,518,889, 5,534,621, 5,656,730,5,763,733, 5,767,260, 5,856,456, assigned to Enzon; U.S. Pat. Nos.5,223,409, 5,403,484, 5,571,698, 5,837,500, assigned to Dyax, U.S. Pat.Nos. 5,427,908, 5,580,717, assigned to Affymax; U.S. Pat. No. 5,885,793,assigned to Cambridge Antibody Technologies; U.S. Pat. No. 5,750,373,assigned to Genentech, U.S. Pat. Nos. 5,618,920, 5,595,898, 5,576,195,5,698,435, 5,693,493, 5,698,417, assigned to Xoma, Colligan, supra;Ausubel, supra; or Sambrook, supra. Antibodies of the present inventioncan also be prepared using at least one anti-IL-6 antibody encodingnucleic acid to provide transgenic animals or mammals, such as goats,cows, horses, sheep, rabbits and the like, that produce such antibodiesin their milk. Such animals can be provided using known methods. See,e.g., but not limited to, U.S. Pat. Nos. 5,827,690; 5,849,992;4,873,316; 5,849,992; 5,994,616; 5,565,362; 5,304,489, and the like,each of which is entirely incorporated herein by reference.

Antibodies of the present invention can additionally be prepared usingat least one anti-IL-6 antibody encoding nucleic acid to providetransgenic plants and cultured plant cells (e.g., but not limited to,tobacco and maize) that produce such antibodies, specified portions orvariants in the plant parts or in cells cultured therefrom. As anon-limiting example, transgenic tobacco leaves expressing recombinantproteins have been successfully used to provide large amounts ofrecombinant proteins, e.g., using an inducible promoter. See, e.g.,Cramer et al., Curr. Top. Microbol. Immunol. 240:95-118 (1999) andreferences cited therein. Also, transgenic maize have been used toexpress mammalian proteins at commercial production levels, withbiological activities equivalent to those produced in other recombinantsystems or purified from natural sources. See, e.g., Hood et al., Adv.Exp. Med. Biol. 464:127-147 (1999) and references cited therein.Antibodies have also been produced in large amounts from transgenicplant seeds including antibody fragments, such as single chainantibodies (scFv's), including tobacco seeds and potato tubers. See,e.g., Conrad et al., Plant Mol. Biol. 38:101-109 (1998) and referencescited therein. Thus, antibodies of the present invention can also beproduced using transgenic plants, according to known methods. See also,e.g., Fischer et al., Biotechnol. Appl. Biochem. 30:99-108 (October,1999), Ma et al., Trends Biotechnol. 13:522-7 (1995); Ma et al., PlantPhysiol. 109:341-6 (1995); Whitelam et al., Biochem. Soc. Trans.22:940-944 (1994); and references cited therein.

The antibodies of the invention can bind human IL-6 with a wide range ofaffinities (K_(D)). In a preferred embodiment, at least one human mAb ofthe present invention can optionally bind human IL-6 with high affinity.For example, a human or human engineered mAb can bind human IL-6 with aK_(D) equal to or less than about 10⁻⁷ M, such as but not limited to,0.1-9.9 (or any range or value therein)×10⁻⁷, 10⁻⁸, 10⁻⁹, 10⁻¹⁰, 10⁻¹¹,10⁻¹², 10⁻¹³, 10⁻¹⁴, 10⁻¹⁵ or any range or value therein, as determinedby surface plasmon resonance or the Kinexa method, as practiced by thoseof skill in the art.

The affinity or avidity of an antibody for an antigen can be determinedexperimentally using any suitable method. (See, for example, Berzofsky,et al., “Antibody-Antigen Interactions,” In Fundamental Immunology,Paul, W. E., Ed., Raven Press: New York, N.Y. (1984); Kuby, JanisImmunology, W. H. Freeman and Company: New York, N.Y. (1992); andmethods described herein). The measured affinity of a particularantibody-antigen interaction can vary if measured under differentconditions (e.g., salt concentration, pH). Thus, measurements ofaffinity and other antigen-binding parameters (e.g., K_(D), K_(on),K_(off)) are preferably made with standardized solutions of antibody andantigen, and a standardized buffer, such as the buffer described herein.

Competitive assays can be performed with the antibody of the presentinvention in order to determine what proteins, antibodies, and otherantagonists compete for binding to IL-6 with the antibody of the presentinvention and/or share the epitope region. These assays as readily knownto those of ordinary skill in the art evaluate competition betweenantagonists or ligands for a limited number of binding sites on aprotein. The protein and/or antibody is immobilized or insolubilizedbefore or after the competition and the sample bound to IL-6 isseparated from the unbound sample, for example, by decanting (where theprotein/antibody was preinsolubilized) or by centrifuging (where theprotein/antibody was precipitated after the competitive reaction). Also,the competitive binding may be determined by whether function is alteredby the binding or lack of binding of the antibody to the protein, e.g.,whether the antibody molecule inhibits or potentiates the enzymaticactivity of, for example, a label. ELISA and other functional assays maybe used, as well known in the art.

Preferred anti-IL-6 antibodies of the invention have the sequences shownin Tables 1-5 and 12-14 below. For example, an anti-IL-6 antibody of theinvention has one of the light chain CDR sequences shown in Table 1(i.e., CDRL1, CDRL2, and CDRL3) and one of the heavy chain CDR sequencesshown in Table 2 (i.e., CDRH1, CDRH2, and CDRH3). More specifically, ananti-IL-6 antibody (molecule AME-A9) has the CDRL1 of SEQ ID NO:15,CDRL2 of SEQ ID NO:27, CDRL3 of SEQ ID NO:35, CDRH1 of SEQ ID NO:47,CDRH2 of SEQ ID NO:61, CDRH3 of SEQ ID NO:91.

Nucleic Acid Molecules

Using the information provided herein, for example, the nucleotidesequences encoding at least 70-100% of the contiguous amino acids of atleast one of the light chain variable regions of SEQ ID NOS: 93, 97, and101, among other sequences disclosed herein, and at least one of theheavy chain variable regions of SEQ ID NOS: 95, 99, and 103, among othersequences disclosed herein, specified fragments, variants or consensussequences thereof, or a deposited vector comprising at least one ofthese sequences, a nucleic acid molecule of the present inventionencoding at least one anti-IL-6 antibody can be obtained using methodsdescribed herein or as known in the art.

Nucleic acid molecules of the present invention can be in the form ofRNA, such as mRNA, hnRNA, tRNA or any other form, or in the form of DNA,including, but not limited to, cDNA and genomic DNA obtained by cloningor produced synthetically, or any combinations thereof. The DNA can betriple-stranded, double-stranded or single-stranded, or any combinationthereof. Any portion of at least one strand of the DNA or RNA can be thecoding strand, also known as the sense strand, or it can be thenon-coding strand, also referred to as the anti-sense strand.

Isolated nucleic acid molecules of the present invention can includenucleic acid molecules comprising an open reading frame (ORF),optionally, with one or more introns, e.g., but not limited to, at leastone specified portion of at least one CDR, such as CDR1, CDR2 and/orCDR3 of at least one heavy chain (e.g., SEQ ID NOS: 38, 40, 42, 44,etc.) or light chain (e.g., SEQ ID NOS: 2, 4, 6, 8, etc.); nucleic acidmolecules comprising the coding sequence for an anti-IL-6 antibody orvariable region (e.g., light chain variable regions of SEQ ID NOS: 94,98, and 102, among other sequences disclosed herein, and heavy chainvariable regions of SEQ ID NOS: 96, 100, and 104); and nucleic acidmolecules which comprise a nucleotide sequence substantially differentfrom those described above but which, due to the degeneracy of thegenetic code, still encode at least one anti-IL-6 antibody as describedherein and/or as known in the art. Of course, the genetic code is wellknown in the art. Thus, it would be routine for one skilled in the artto generate such degenerate nucleic acid variants that code for specificanti-IL-6 antibodies of the present invention. See, e.g., Ausubel, etal., supra, and such nucleic acid variants are included in the presentinvention.

As indicated herein, nucleic acid molecules of the present inventionwhich comprise a nucleic acid encoding an anti-IL-6 antibody caninclude, but are not limited to, those encoding the amino acid sequenceof an antibody fragment, by itself; the coding sequence for the entireantibody or a portion thereof; the coding sequence for an antibody,fragment or portion, as well as additional sequences, such as the codingsequence of at least one signal leader or fusion peptide, with orwithout the aforementioned additional coding sequences, such as at leastone intron, together with additional, non-coding sequences, includingbut not limited to, non-coding 5′ and 3′ sequences, such as thetranscribed, non-translated sequences that play a role in transcription,mRNA processing, including splicing and polyadenylation signals (forexample, ribosome binding and stability of mRNA); an additional codingsequence that codes for additional amino acids, such as those thatprovide additional functionalities. Thus, the sequence encoding anantibody can be fused to a marker sequence, such as a sequence encodinga peptide that facilitates purification of the fused antibody comprisingan antibody fragment or portion.

Polynucleotides Selectively Hybridizing to a Polynucleotide as DescribedHerein

The present invention provides isolated nucleic acids that hybridizeunder selective hybridization conditions to a polynucleotide disclosedherein. Thus, the polynucleotides of this embodiment can be used forisolating, detecting, and/or quantifying nucleic acids comprising suchpolynucleotides. For example, polynucleotides of the present inventioncan be used to identify, isolate, or amplify partial or full-lengthclones in a deposited library. In some embodiments, the polynucleotidesare genomic or cDNA sequences isolated, or otherwise complementary to, acDNA from a human or mammalian nucleic acid library.

Preferably, the cDNA library comprises at least 80% full-lengthsequences, preferably, at least 85% or 90% full-length sequences, and,more preferably, at least 95% full-length sequences. The cDNA librariescan be normalized to increase the representation of rare sequences. Lowor moderate stringency hybridization conditions are typically, but notexclusively, employed with sequences having a reduced sequence identityrelative to complementary sequences. Moderate and high stringencyconditions can optionally be employed for sequences of greater identity.Low stringency conditions allow selective hybridization of sequenceshaving about 70% sequence identity and can be employed to identifyorthologous or paralogous sequences.

Optionally, polynucleotides of this invention will encode at least aportion of an antibody encoded by the polynucleotides described herein.The polynucleotides of this invention embrace nucleic acid sequencesthat can be employed for selective hybridization to a polynucleotideencoding an antibody of the present invention. See, e.g., Ausubel,supra; Colligan, supra, each entirely incorporated herein by reference.

Construction of Nucleic Acids

The isolated nucleic acids of the present invention can be made using(a) recombinant methods, (b) synthetic techniques, (c) purificationtechniques, and/or (d) combinations thereof, as well-known in the art.

The nucleic acids can conveniently comprise sequences in addition to apolynucleotide of the present invention. For example, a multi-cloningsite comprising one or more endonuclease restriction sites can beinserted into the nucleic acid to aid in isolation of thepolynucleotide. Also, translatable sequences can be inserted to aid inthe isolation of the translated polynucleotide of the present invention.For example, a hexa-histidine marker sequence provides a convenientmeans to purify the proteins of the present invention. The nucleic acidof the present invention, excluding the coding sequence, is optionally avector, adapter, or linker for cloning and/or expression of apolynucleotide of the present invention.

Additional sequences can be added to such cloning and/or expressionsequences to optimize their function in cloning and/or expression, toaid in isolation of the polynucleotide, or to improve the introductionof the polynucleotide into a cell. Use of cloning vectors, expressionvectors, adapters, and linkers is well known in the art. (See, e.g.,Ausubel, supra; or Sambrook, supra)

Recombinant Methods for Constructing Nucleic Acids

The isolated nucleic acid compositions of this invention, such as RNA,cDNA, genomic DNA, or any combination thereof, can be obtained frombiological sources using any number of cloning methodologies known tothose of skill in the art. In some embodiments, oligonucleotide probesthat selectively hybridize, under stringent conditions, to thepolynucleotides of the present invention are used to identify thedesired sequence in a cDNA or genomic DNA library. The isolation of RNA,and construction of cDNA and genomic libraries, are well known to thoseof ordinary skill in the art. (See, e.g., Ausubel, supra; or Sambrook,supra)

Nucleic Acid Screening and Isolation Methods

A cDNA or genomic library can be screened using a probe based upon thesequence of a polynucleotide of the present invention, such as thosedisclosed herein. Probes can be used to hybridize with genomic DNA orcDNA sequences to isolate homologous genes in the same or differentorganisms. Those of skill in the art will appreciate that variousdegrees of stringency of hybridization can be employed in the assay; andeither the hybridization or the wash medium can be stringent. As theconditions for hybridization become more stringent, there must be agreater degree of complementarity between the probe and the target forduplex formation to occur. The degree of stringency can be controlled byone or more of temperature, ionic strength, pH and the presence of apartially denaturing solvent, such as formamide. For example, thestringency of hybridization is conveniently varied by changing thepolarity of the reactant solution through, for example, manipulation ofthe concentration of formamide within the range of 0% to 50%. The degreeof complementarity (sequence identity) required for detectable bindingwill vary in accordance with the stringency of the hybridization mediumand/or wash medium. The degree of complementarity will optimally be100%, or 70-100%, or any range or value therein. However, it should beunderstood that minor sequence variations in the probes and primers canbe compensated for by reducing the stringency of the hybridizationand/or wash medium.

Methods of amplification of RNA or DNA are well known in the art and canbe used according to the present invention without undueexperimentation, based on the teaching and guidance presented herein.

Known methods of DNA or RNA amplification include, but are not limitedto, polymerase chain reaction (PCR) and related amplification processes(see, e.g., U.S. Pat. Nos. 4,683,195, 4,683,202, 4,800,159, 4,965,188,to Mullis, et al.; U.S. Pat. Nos. 4,795,699 and 4,921,794 to Tabor, etal; U.S. Pat. No. 5,142,033 to Innis; U.S. Pat. No. 5,122,464 to Wilson,et al.; U.S. Pat. No. 5,091,310 to Innis; U.S. Pat. No. 5,066,584 toGyllensten, et al; U.S. Pat. No. 4,889,818 to Gelfand, et al; U.S. Pat.No. 4,994,370 to Silver, et al; U.S. Pat. No. 4,766,067 to Biswas; U.S.Pat. No. 4,656,134 to Ringold) and RNA mediated amplification that usesanti-sense RNA to the target sequence as a template for double-strandedDNA synthesis (U.S. Pat. No. 5,130,238 to Malek, et al, with thetradename NASBA), the entire contents of which references areincorporated herein by reference. (See, e.g., Ausubel, supra; orSambrook, supra.)

For instance, polymerase chain reaction (PCR) technology can be used toamplify the sequences of polynucleotides of the present invention andrelated genes directly from genomic DNA or cDNA libraries. PCR and otherin vitro amplification methods can also be useful, for example, to clonenucleic acid sequences that code for proteins to be expressed, to makenucleic acids to use as probes for detecting the presence of the desiredmRNA in samples, for nucleic acid sequencing, or for other purposes.Examples of techniques sufficient to direct persons of skill through invitro amplification methods are found in Berger, supra, Sambrook, supra,and Ausubel, supra, as well as Mullis, et al., U.S. Pat. No. 4,683,202(1987); and Innis, et al., PCR Protocols A Guide to Methods andApplications, Eds., Academic Press Inc., San Diego, Calif. (1990).Commercially available kits for genomic PCR amplification are known inthe art. See, e.g., Advantage-GC Genomic PCR Kit (Clontech).Additionally, e.g., the T4 gene 32 protein (Boehringer Mannheim) can beused to improve yield of long PCR products.

Synthetic Methods for Constructing Nucleic Acids

The isolated nucleic acids of the present invention can also be preparedby direct chemical synthesis by known methods (see, e.g., Ausubel, etal., supra). Chemical synthesis generally produces a single-strandedoligonucleotide, which can be converted into double-stranded DNA byhybridization with a complementary sequence, or by polymerization with aDNA polymerase using the single strand as a template. One of skill inthe art will recognize that while chemical synthesis of DNA can belimited to sequences of about 100 or more bases, longer sequences can beobtained by the ligation of shorter sequences.

Recombinant Expression Cassettes

The present invention further provides recombinant expression cassettescomprising a nucleic acid of the present invention. A nucleic acidsequence of the present invention, for example, a cDNA or a genomicsequence encoding an antibody of the present invention, can be used toconstruct a recombinant expression cassette that can be introduced intoat least one desired host cell. A recombinant expression cassette willtypically comprise a polynucleotide of the present invention operablylinked to transcriptional initiation regulatory sequences that willdirect the transcription of the polynucleotide in the intended hostcell. Both heterologous and non-heterologous (i.e., endogenous)promoters can be employed to direct expression of the nucleic acids ofthe present invention.

In some embodiments, isolated nucleic acids that serve as promoter,enhancer, or other elements can be introduced in the appropriateposition (upstream, downstream or in the intron) of a non-heterologousform of a polynucleotide of the present invention so as to up or downregulate expression of a polynucleotide of the present invention. Forexample, endogenous promoters can be altered in vivo or in vitro bymutation, deletion and/or substitution.

Vectors and Host Cells

The present invention also relates to vectors that include isolatednucleic acid molecules of the present invention, host cells that aregenetically engineered with the recombinant vectors, and the productionof at least one anti-IL-6 antibody by recombinant techniques, as is wellknown in the art. See, e.g., Sambrook, et al., supra; Ausubel, et al.,supra, each entirely incorporated herein by reference.

The polynucleotides can optionally be joined to a vector containing aselectable marker for propagation in a host. Generally, a plasmid vectoris introduced in a precipitate, such as a calcium phosphate precipitate,or in a complex with a charged lipid. If the vector is a virus, it canbe packaged in vitro using an appropriate packaging cell line and thentransduced into host cells.

The DNA insert should be operatively linked to an appropriate promoter.The expression constructs will further contain sites for transcriptioninitiation, termination and, in the transcribed region, a ribosomebinding site for translation. The coding portion of the maturetranscripts expressed by the constructs will preferably include atranslation initiating at the beginning and a termination codon (e.g.,UAA, UGA or UAG) appropriately positioned at the end of the mRNA to betranslated, with UAA and UAG preferred for mammalian or eukaryotic cellexpression.

Expression vectors will preferably but optionally include at least oneselectable marker. Such markers include, e.g., but are not limited to,methotrexate (MTX), dihydrofolate reductase (DHFR, U.S. Pat. Nos.4,399,216; 4,634,665; 4,656,134; 4,956,288; 5,149,636; 5,179,017,ampicillin, neomycin (G418), mycophenolic acid, or glutamine synthetase(GS, U.S. Pat. Nos. 5,122,464; 5,770,359; 5,827,739) resistance foreukaryotic cell culture, and tetracycline or ampicillin resistance genesfor culturing in E. coli and other bacteria or prokaryotics (the abovepatents are entirely incorporated hereby by reference). Appropriateculture mediums and conditions for the above-described host cells areknown in the art. Suitable vectors will be readily apparent to theskilled artisan. Introduction of a vector construct into a host cell canbe effected by calcium phosphate transfection, DEAE-dextran mediatedtransfection, cationic lipid-mediated transfection, electroporation,transduction, infection or other known methods. Such methods aredescribed in the art, such as Sambrook, supra, Chapters 1-4 and 16-18;Ausubel, supra, Chapters 1, 9, 13, 15, 16.

At least one antibody of the present invention can be expressed in amodified form, such as a fusion protein, and can include not onlysecretion signals, but also additional heterologous functional regions.For instance, a region of additional amino acids, particularly chargedamino acids, can be added to the N-terminus of an antibody to improvestability and persistence in the host cell, during purification, orduring subsequent handling and storage. Also, peptide moieties can beadded to an antibody of the present invention to facilitatepurification. Such regions can be removed prior to final preparation ofan antibody or at least one fragment thereof. Such methods are describedin many standard laboratory manuals, such as Sambrook, supra, Chapters17.29-17.42 and 18.1-18.74; Ausubel, supra, Chapters 16, 17 and 18.

Those of ordinary skill in the art are knowledgeable in the numerousexpression systems available for expression of a nucleic acid encoding aprotein of the present invention. Alternatively, nucleic acids of thepresent invention can be expressed in a host cell by turning on (bymanipulation) in a host cell that contains endogenous DNA encoding anantibody of the present invention. Such methods are well known in theart, e.g., as described in U.S. Pat. Nos. 5,580,734, 5,641,670,5,733,746, and 5,733,761, entirely incorporated herein by reference.

Illustrative of cell cultures useful for the production of theantibodies, specified portions or variants thereof, are mammalian cells.Mammalian cell systems often will be in the form of monolayers of cellsalthough mammalian cell suspensions or bioreactors can also be used. Anumber of suitable host cell lines capable of expressing intactglycosylated proteins have been developed in the art, and include theCOS-1 (e.g., ATCC CRL 1650), COS-7 (e.g., ATCC CRL-1651), HEK293, BHK21(e.g., ATCC CRL-10), CHO (e.g., ATCC CRL 1610) and BSC-1 (e.g., ATCCCRL-26) cell lines, Cos-7 cells, CHO cells, hep G2 cells, P3X63Ag8.653,SP2/0-Ag14, 293 cells, HeLa cells and the like, which are readilyavailable from, for example, American Type Culture Collection, Manassas,Va. (www.atcc.org). Preferred host cells include cells of lymphoidorigin, such as myeloma and lymphoma cells. Particularly preferred hostcells are P3X63Ag8.653 cells (ATCC Accession Number CRL-1580) andSP2/0-Ag14 cells (ATCC Accession Number CRL-1851). In a particularlypreferred embodiment, the recombinant cell is a P3X63Ab8.653 or aSP2/0-Ag14 cell.

Expression vectors for these cells can include one or more of thefollowing expression control sequences, such as, but not limited to, anorigin of replication; a promoter (e.g., late or early SV40 promoters,the CMV promoter (U.S. Pat. Nos. 5,168,062; 5,385,839), an HSV tkpromoter, a pgk (phosphoglycerate kinase) promoter, an EF-1 alphapromoter (U.S. Pat. No. 5,266,491), at least one human immunoglobulinpromoter; an enhancer, and/or processing information sites, such asribosome binding sites, RNA splice sites, polyadenylation sites (e.g.,an SV40 large T Ag poly A addition site), and transcriptional terminatorsequences. See, e.g., Ausubel et al., supra; Sambrook, et al., supra.Other cells useful for production of nucleic acids or proteins of thepresent invention are known and/or available, for instance, from theAmerican Type Culture Collection Catalogue of Cell Lines and Hybridomas(www.atcc.org) or other known or commercial sources.

When eukaryotic host cells are employed, polyadenlyation ortranscription terminator sequences are typically incorporated into thevector. An example of a terminator sequence is the polyadenlyationsequence from the bovine growth hormone gene. Sequences for accuratesplicing of the transcript can also be included. An example of asplicing sequence is the VP1 intron from SV40 (Sprague, et al., J.Virol. 45:773-781 (1983)). Additionally, gene sequences to controlreplication in the host cell can be incorporated into the vector, asknown in the art.

Purification of an Antibody

An anti-IL-6 antibody can be recovered and purified from recombinantcell cultures by well-known methods including, but not limited to,protein A purification, ammonium sulfate or ethanol precipitation, acidextraction, anion or cation exchange chromatography, phosphocellulosechromatography, hydrophobic interaction chromatography, affinitychromatography, hydroxylapatite chromatography and lectinchromatography. High performance liquid chromatography (“HPLC”) can alsobe employed for purification. See, e.g., Colligan, Current Protocols inImmunology, or Current Protocols in Protein Science, John Wiley & Sons,NY, N.Y., (1997-2001), e.g., Chapters 1, 4, 6, 8, 9, 10, each entirelyincorporated herein by reference.

Antibodies of the present invention include naturally purified products,products of chemical synthetic procedures, and products produced byrecombinant techniques from a eukaryotic host, including, for example,yeast, higher plant, insect and mammalian cells. Depending upon the hostemployed in a recombinant production procedure, the antibody of thepresent invention can be glycosylated or can be non-glycosylated, withglycosylated preferred. Such methods are described in many standardlaboratory manuals, such as Sambrook, supra, Sections 17.37-17.42;Ausubel, supra, Chapters 10, 12, 13, 16, 18 and 20, Colligan, ProteinScience, supra, Chapters 12-14, all entirely incorporated herein byreference.

Anti-IL-6 Antibodies

An anti-IL-6 antibody according to the present invention includes anyprotein or peptide containing molecule that comprises at least a portionof an immunoglobulin molecule, such as but not limited to, at least oneligand binding portion (LBP), such as but not limited to, acomplementarity determining region (CDR) of a heavy or light chain or aligand binding portion thereof, a heavy chain or light chain variableregion, a framework region (e.g., FR1, FR2, FR3, FR4 or fragmentthereof, or as shown in SEQ ID NOS: 105-112, further optionallycomprising at least one substitution, insertion or deletion), a heavychain or light chain constant region, (e.g., comprising at least one CHLhinge1, hinge2, hinge3, hinge4, CH2, or CH3 or fragment thereof, furtheroptionally comprising at least one substitution, insertion or deletion),or any portion thereof, that can be incorporated into an antibody of thepresent invention. An antibody of the invention can include or bederived from any mammal, such as but not limited to, a human, a mouse, arabbit, a rat, a rodent, a primate, or any combination thereof, and thelike.

The isolated antibodies of the present invention comprise the antibodyamino acid sequences disclosed herein encoded by any suitablepolynucleotide, or any isolated or prepared antibody. Preferably, thehuman antibody or antigen-binding fragment binds human IL-6 and,thereby, partially or substantially neutralizes at least one biologicalactivity of the protein. An antibody, or specified portion or variantthereof, that partially or preferably substantially neutralizes at leastone biological activity of at least one IL-6 protein or fragment canbind the protein or fragment and thereby inhibit activities mediatedthrough the binding of IL-6 to the IL-6 receptor or through otherIL-6-dependent or mediated mechanisms. As used herein, the term“neutralizing antibody” refers to an antibody that can inhibit anIL-6-dependent activity by about 20-120%, preferably by at least about10, 20, 30, 40, 50, 55, 60, 65, 70, 75, 80, 85, 90, 91, 92, 93, 94, 95,96, 97, 98, 99, 100% or more depending on the assay. The capacity of ananti-IL-6 antibody to inhibit an IL-6-dependent activity is preferablyassessed by at least one suitable IL-6 protein or receptor assay, asdescribed herein and/or as known in the art. A human antibody of theinvention can be of any class (IgG, IgA, IgM, IgE, IgD, etc.) or isotypeand can comprise a kappa or lambda light chain. In one embodiment, thehuman antibody comprises an IgG heavy chain or defined fragment, forexample, at least one of isotypes, IgG1, IgG2, IgG3 or IgG4 (e.g., γ1,□γ2, γ3, or γ4). Antibodies of this type can be prepared by employing atransgenic mouse or other transgenic non-human mammal comprising atleast one human light chain (e.g., IgG, IgA, and IgM) transgenes asdescribed herein and/or as known in the art. In another embodiment, theanti-human IL-6 human antibody comprises an IgG1 heavy chain and an IgG1light chain.

At least one antibody of the invention binds at least one specifiedepitope specific to at least one IL-6 protein, subunit, fragment,portion or any combination thereof. The at least one epitope cancomprise at least one antibody binding region that comprises at leastone portion of the protein, which epitope is preferably comprised of atleast one extracellular, soluble, hydrophillic, external or cytoplasmicportion of the protein. The at least one specified epitope can compriseany combination of at least one amino acid sequence of at least 1-3amino acids to the entire specified portion of contiguous amino acids ofSEQ ID NO:115, for example, amino acid residues 151-178, morespecifically, residues 171-182.

Generally, the human antibody or antigen-binding fragment of the presentinvention will comprise an antigen-binding region that comprises atleast one human complementarity determining region (CDR1, CDR2 and CDR3)or variant of at least one heavy chain variable region and at least onehuman complementarity determining region (CDR1, CDR2 and CDR3) orvariant of at least one light chain variable region. The CDR sequencesmay be derived from human germline sequences or closely match thegermline sequences. For example, the CDRs from a synthetic libraryderived from the original mouse CDRs can be used. These CDRs may beformed by incorporation of conservative substitutions from the originalmouse sequence. As a non-limiting example, the antibody orantigen-binding portion or variant can comprise at least one of theheavy chain CDR3 having an amino acid sequence selected from the groupconsisting of SEQ ID NOS: 79, 81, 83, 85, 87, 89, and 91, and/or a lightchain CDR3 having an amino acid sequence selected from the groupconsisting of SEQ ID NOS:29, 31, 33, and 35. In a particular embodiment,the antibody or antigen-binding fragment can have an antigen-bindingregion that comprises at least a portion of at least one heavy chain CDR(i.e., CDR1, CDR2 and/or CDR3) having the amino acid sequence of thecorresponding CDRs 1, 2, and/or 3 (e.g., SEQ ID NOS:37, 49, and 79). Inanother particular embodiment, the antibody or antigen-binding portionor variant can have an antigen-binding region that comprises at least aportion of at least one light chain CDR (i.e., CDR1, CDR2 and/or CDR3)having the amino acid sequence of the corresponding CDRs 1, 2 and/or 3(e.g., SEQ ID NOS:1, 17, and 29).

In a preferred embodiment, the three heavy chain CDRs and the threelight chain CDRs of the antibody or antigen-binding fragment have theamino acid sequence of the corresponding CDR of at least one of mAbAME-A9, AME-1b, AME-18a, AME-22a, AME-20b, AME-23a, and AME-19a, asdescribed herein. Such antibodies can be prepared by chemically joiningtogether the various portions (e.g., CDRs, framework) of the antibodyusing conventional techniques, by preparing and expressing a (i.e., oneor more) nucleic acid molecule that encodes the antibody usingconventional techniques of recombinant DNA technology or by using anyother suitable method.

The anti-IL-6 antibody can comprise at least one of a heavy or lightchain variable region having a defined amino acid sequence. For example,in a preferred embodiment, the anti-IL-6 antibody comprises at least oneof at least one heavy chain variable region, optionally having an aminoacid sequence selected from the group consisting of SEQ ID NOS:95, 99,103, 118, 122, 126, and 130, and/or at least one light chain variableregion, optionally having an amino acid sequence selected from the groupconsisting of SEQ ID NOS:93, 97, 101, 116, 120, 124, and 128. Antibodiesthat bind to human IL-6 and that comprise a defined heavy or light chainvariable region can be prepared using suitable methods, such as phagedisplay (Katsube, Y., et al., Int J Mol. Med, 1(5):863-868 (1998)) ormethods that employ transgenic animals, as known in the art and/or asdescribed herein. For example, a transgenic mouse, comprising afunctionally rearranged human immunoglobulin heavy chain transgene and atransgene comprising DNA from a human immunoglobulin light chain locusthat can undergo functional rearrangement, can be immunized with humanIL-6 or a fragment thereof to elicit the production of antibodies. Ifdesired, the antibody producing cells can be isolated and hybridomas orother immortalized antibody-producing cells can be prepared as describedherein and/or as known in the art. Alternatively, the antibody,specified portion or variant can be expressed using the encoding nucleicacid or portion thereof in a suitable host cell.

Amino Acid Codes

The amino acids that make up anti-IL-6 antibodies of the presentinvention are often abbreviated. The amino acid designations can beindicated by designating the amino acid by its single letter code, itsthree letter code, name, or three nucleotide codon(s) as is wellunderstood in the art (see Alberts, B., et al., Molecular Biology of TheCell, Third Ed., Garland Publishing, Inc., New York, 1994)

An anti-IL-6 antibody of the present invention can include one or moreamino acid substitutions, deletions or additions, either from naturalmutations or human manipulation, as specified herein. Amino acids in ananti-IL-6 antibody of the present invention that are essential forfunction can be identified by methods known in the art, such assite-directed mutagenesis or alanine-scanning mutagenesis (e.g.,Ausubel, supra, Chapters 8, 15; Cunningham and Wells, Science244:1081-1085 (1989)). The latter procedure introduces single alaninemutations at every residue in the molecule. The resulting mutantmolecules are then tested for biological activity, such as, but notlimited to, at least one IL-6 neutralizing activity. Sites that arecritical for antibody binding can also be identified by structuralanalysis, such as crystallization, nuclear magnetic resonance orphotoaffinity labeling (Smith, et al., J. Mol. Biol. 224:899-904 (1992)and de Vos, et al., Science 255:306-312 (1992)).

Anti-IL-6 antibodies of the present invention can include, but are notlimited to, at least one portion, sequence or combination selected from5 to all of the contiguous amino acids of at least one of SEQ ID NOS:91, 93, 95, 97, 99, etc.

Non-limiting variants that can enhance or maintain at least one of thelisted activities include, but are not limited to, any of the abovepolypeptides, further comprising at least one mutation corresponding toat least one substitution in the residues varied among the disclosedvariant amino acid sequences.

An anti-IL-6 antibody can further optionally comprise a polypeptide withan amino acid sequence that varies from the sequence of the contiguousamino acids of at least one of SEQ ID NOS:95, 99, and 103, etc (e.g.,one or more conservative substitutions from the sequences providedherein). Also, the present invention comprises variants of the aminoacid sequence of a light chain variable region of SEQ ID NOS:93, 97, or101, or the amino acid sequence of a heavy chain of SEQ ID NOS: 79, 81,83, 85, 87, 89, or 91.

As those of skill will appreciate, the present invention includes atleast one biologically active antibody of the present invention.Biologically active antibodies have a specific activity at least 20%,30%, or 40%, and, preferably, at least 50%, 60%, or 70%, and, mostpreferably, at least 80%, 90%, or 95%-1000% or more of that of thenative (non-synthetic), endogenous or related and known antibody.Methods of assaying and quantifying measures of enzymatic activity andsubstrate specificity are well known to those of skill in the art.

In another aspect, the invention relates to human antibodies andantigen-binding fragments, as described herein, which are modified bythe covalent attachment of an organic moiety. Such modification canproduce an antibody or antigen-binding fragment with improvedpharmacokinetic properties (e.g., increased in vivo serum half-life).The organic moiety can be a linear or branched hydrophilic polymericgroup, fatty acid group, or fatty acid ester group. In particularembodiments, the hydrophilic polymeric group can have a molecular weightof about 800 to about 120,000 Daltons and can be a polyalkane glycol(e.g., polyethylene glycol (PEG), polypropylene glycol (PPG)),carbohydrate polymer, amino acid polymer or polyvinyl pyrolidone, andthe fatty acid or fatty acid ester group can comprise from about eightto about forty carbon atoms.

The modified antibodies and antigen-binding fragments of the inventioncan comprise one or more organic moieties that are covalently bonded,directly or indirectly, to the antibody. Each organic moiety that isbonded to an antibody or antigen-binding fragment of the invention canindependently be a hydrophilic polymeric group, a fatty acid group or afatty acid ester group. As used herein, the term “fatty acid”encompasses mono-carboxylic acids and di-carboxylic acids. A“hydrophilic polymeric group,” as the term is used herein, refers to anorganic polymer that is more soluble in water than in octane. Forexample, polylysine is more soluble in water than in octane. Thus, anantibody modified by the covalent attachment of polylysine isencompassed by the invention. Hydrophilic polymers suitable formodifying antibodies of the invention can be linear or branched andinclude, for example, polyalkane glycols (e.g., PEG,monomethoxy-polyethylene glycol (mPEG), PPG and the like), carbohydrates(e.g., dextran, cellulose, oligosaccharides, polysaccharides and thelike), polymers of hydrophilic amino acids (e.g., polylysine,polyarginine, polyaspartate and the like), polyalkane oxides (e.g.,polyethylene oxide, polypropylene oxide and the like) and polyvinylpyrolidone. Preferably, the hydrophilic polymer that modifies theantibody of the invention has a molecular weight of about 800 to about150,000 Daltons as a separate molecular entity. For example, PEG₅₀₀₀ andPEG_(20,000), wherein the subscript is the average molecular weight ofthe polymer in Daltons, can be used. The hydrophilic polymeric group canbe substituted with one to about six alkyl, fatty acid or fatty acidester groups. Hydrophilic polymers that are substituted with a fattyacid or fatty acid ester group can be prepared by employing suitablemethods. For example, a polymer comprising an amine group can be coupledto a carboxylate of the fatty acid or fatty acid ester, and an activatedcarboxylate (e.g., activated with N, N-carbonyl diimidazole) on a fattyacid or fatty acid ester can be coupled to a hydroxyl group on apolymer.

Fatty acids and fatty acid esters suitable for modifying antibodies ofthe invention can be saturated or can contain one or more units ofunsaturation. Fatty acids that are suitable for modifying antibodies ofthe invention include, for example, n-dodecanoate (C₁₂, laurate),n-tetradecanoate (C₁₄, myristate), n-octadecanoate (C₁₈, stearate),n-eicosanoate (C₂₀, arachidate), n-docosanoate (C₂₂, behenate),n-triacontanoate (C₃₀), n-tetracontanoate (C₄₀), cis-Δ9-octadecanoate(C₁₈, oleate), all cis-Δ5,8,11,14-eicosatetraenoate (C₂₀, arachidonate),octanedioic acid, tetradecanedioic acid, octadecanedioic acid,docosanedioic acid, and the like. Suitable fatty acid esters includemono-esters of dicarboxylic acids that comprise a linear or branchedlower alkyl group. The lower alkyl group can comprise from one to abouttwelve, preferably, one to about six, carbon atoms.

The modified human antibodies and antigen-binding fragments can beprepared using suitable methods, such as by reaction with one or moremodifying agents. A “modifying agent” as the term is used herein, refersto a suitable organic group (e.g., hydrophilic polymer, a fatty acid, afatty acid ester) that comprises an activating group. An “activatinggroup” is a chemical moiety or functional group that can, underappropriate conditions, react with a second chemical group therebyforming a covalent bond between the modifying agent and the secondchemical group. For example, amine-reactive activating groups includeelectrophilic groups, such as tosylate, mesylate, halo (chloro, bromo,fluoro, iodo), N-hydroxysuccinimidyl esters (NHS), and the like.Activating groups that can react with thiols include, for example,maleimide, iodoacetyl, acrylolyl, pyridyl disulfides,5-thiol-2-nitrobenzoic acid thiol (TNB-thiol), and the like. An aldehydefunctional group can be coupled to amine- or hydrazide-containingmolecules, and an azide group can react with a trivalent phosphorousgroup to form phosphoramidate or phosphorimide linkages. Suitablemethods to introduce activating groups into molecules are known in theart (see for example, Hermanson, G. T., Bioconjugate Techniques,Academic Press: San Diego, Calif. (1996)). An activating group can bebonded directly to the organic group (e.g., hydrophilic polymer, fattyacid, fatty acid ester), or through a linker moiety, for example, adivalent C₁-C₁₂ group wherein one or more carbon atoms can be replacedby a heteroatom, such as oxygen, nitrogen or sulfur. Suitable linkermoieties include, for example, tetraethylene glycol, —(CH₂)₃—,—NH—(CH₂)₆—NH—, —(CH₂)₂—NH— and —CH₂—O—CH₂—CH₂—O—CH₂—CH₂—O—CH—NH—.Modifying agents that comprise a linker moiety can be produced, forexample, by reacting a mono-Boc-alkyldiamine (e.g.,mono-Boc-ethylenediamine, mono-Boc-diaminohexane) with a fatty acid inthe presence of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) toform an amide bond between the free amine and the fatty acidcarboxylate. The Boc protecting group can be removed from the product bytreatment with trifluoroacetic acid (TFA) to expose a primary amine thatcan be coupled to another carboxylate, as described, or can be reactedwith maleic anhydride and the resulting product cyclized to produce anactivated maleimido derivative of the fatty acid. (See, for example,Thompson, et al., WO 92/16221, the entire teachings of which areincorporated herein by reference.)

The modified antibodies of the invention can be produced by reacting ahuman antibody or antigen-binding fragment with a modifying agent. Forexample, the organic moieties can be bonded to the antibody in anon-site specific manner by employing an amine-reactive modifying agent,for example, an NHS ester of PEG. Modified human antibodies orantigen-binding fragments can also be prepared by reducing disulfidebonds (e.g., intra-chain disulfide bonds) of an antibody orantigen-binding fragment. The reduced antibody or antigen-bindingfragment can then be reacted with a thiol-reactive modifying agent toproduce the modified antibody of the invention. Modified humanantibodies and antigen-binding fragments comprising an organic moietythat is bonded to specific sites of an antibody of the present inventioncan be prepared using suitable methods, such as reverse proteolysis(Fisch et al., Bioconjugate Chem., 3:147-153 (1992); Werlen et al.,Bioconjugate Chem., 5:411-417 (1994); Kumaran et al., Protein Sci.6(10):2233-2241 (1997); Itoh et al., Bioorg. Chem., 24(1): 59-68 (1996);Capellas et al., Biotechnol. Bioeng., 56(4):456-463 (1997)), and themethods described in Hermanson, G. T., Bioconjugate Techniques, AcademicPress: San Diego, Calif. (1996).

Anti-Idiotype Antibodies to Anti-Il-6 Antibody Compositions

In addition to monoclonal anti-IL-6 antibodies, the present invention isalso directed to an anti-idiotypic (anti-Id) antibody specific for suchantibodies of the invention. An anti-Id antibody is an antibody whichrecognizes unique determinants generally associated with theantigen-binding region of another antibody. The anti-Id can be preparedby immunizing an animal of the same species and genetic type (e.g.,mouse strain) as the source of the Id antibody with the antibody or aCDR containing region thereof. The immunized animal will recognize andrespond to the idiotypic determinants of the immunizing antibody andproduce an anti-Id antibody. The anti-Id antibody may also be used as an“immunogen” to induce an immune response in yet another animal,producing a so-called anti-anti-Id antibody.

The present invention also provides at least one anti-IL-6 antibodycomposition comprising at least one, at least two, at least three, atleast four, at least five, at least six or more anti-IL-6 antibodiesthereof, as described herein and/or as known in the art that areprovided in a non-naturally occurring composition, mixture or form. Suchcompositions comprise non-naturally occurring compositions comprising atleast one or two full length, C- and/or N-terminally deleted variants,domains, fragments, or specified variants, of the anti-IL-6 antibodyamino acid sequence selected from the group consisting of 70-100% of thecontiguous amino acids of SEQ ID NOS:1-114 and 116-138, or specifiedfragments, domains or variants thereof. Preferred anti-IL-6 antibodycompositions include at least one or two full length, fragments, domainsor variants as at least one CDR or LBP containing portions of theanti-IL-6 antibody sequence described herein, for example, 70-100% ofSEQ ID NOS:15, 27, 35, 47, 61, and 91, or specified fragments, domainsor variants thereof. Further preferred compositions comprise, forexample, 40-99% of at least one of 70-100% of SEQ ID NOS: 93, 95, 97,99, 101, 103, etc., or specified fragments, domains or variants thereof.Such composition percentages are by weight, volume, concentration,molarity, or molality as liquid or dry solutions, mixtures, suspension,emulsions, particles, powder, or colloids, as known in the art or asdescribed herein.

Antibody Compositions Comprising Further Therapeutically ActiveIngredients

The antibody compositions of the invention can optionally furthercomprise an effective amount of at least one compound or proteinselected from at least one of an anti-infective drug, a cardiovascular(CV) system drug, a central nervous system (CNS) drug, an autonomicnervous system (ANS) drug, a respiratory tract drug, a gastrointestinal(GI) tract drug, a hormonal drug, a drug for fluid or electrolytebalance, a hematologic drug, an antineoplastic, an immunomodulationdrug, an ophthalmic, otic or nasal drug, a topical drug, a nutritionaldrug or the like. Such drugs are well known in the art, includingformulations, indications, dosing and administration for each presentedherein (see, e.g., Nursing 2001 Handbook of Drugs, 21^(st) edition,Springhouse Corp., Springhouse, Pa., 2001; Health Professional's DrugGuide 2001, ed., Shannon, Wilson, Stang, Prentice-Hall, Inc, UpperSaddle River, N.J.; Pharmcotherapy Handbook, Wells et al., ed., Appleton& Lange, Stamford, Conn., each entirely incorporated herein byreference).

The anti-infective drug can be at least one selected from amebicides orat least one antiprotozoals, anthelmintics, antifungals, antimalarials,antituberculotics or at least one antileprotics, aminoglycosides,penicillins, cephalosporins, tetracyclines, sulfonamides,fluoroquinolones, antivirals, macrolide anti-infectives, andmiscellaneous anti-infectives. The CV drug can be at least one selectedfrom inotropics, antiarrhythmics, antianginals, antihypertensives,antilipemics, and miscellaneous cardiovascular drugs. The CNS drug canbe at least one selected from nonnarcotic analgesics or at least oneselected from antipyretics, nonsteroidal anti-inflammatory drugs,narcotic or at least one opioid analgesics, sedative-hypnotics,anticonvulsants, antidepressants, antianxiety drugs, antipsychotics,central nervous system stimulants, antiparkinsonians, and miscellaneouscentral nervous system drugs. The ANS drug can be at least one selectedfrom cholinergics (parasympathomimetics), anticholinergics, adrenergics(sympathomimetics), adrenergic blockers (sympatholytics), skeletalmuscle relaxants, and neuromuscular blockers. The respiratory tract drugcan be at least one selected from antihistamines, bronchodilators,expectorants or at least one antitussive, and miscellaneous respiratorydrugs. The GI tract drug can be at least one selected from antacids orat least one adsorbent or at least one antiflatulent, digestive enzymeor at least one gallstone solubilizer, antidiarrheals, laxatives,antiemetics, and antiulcer drugs. The hormonal drug can be at least oneselected from corticosteroids, androgens or at least one anabolicsteroid, estrogen or at least one progestin, gonadotropin, antidiabeticdrug or at least one glucagon, thyroid hormone, thyroid hormoneantagonist, pituitary hormone, and parathyroid-like drug. The drug forfluid and electrolyte balance can be at least one selected fromdiuretics, electrolytes or at least one replacement solution, acidifieror at least one alkalinizer. The hematologic drug can be at least oneselected from hematinics, anticoagulants, blood derivatives, andthrombolytic enzymes. The antineoplastics can be at least one selectedfrom alkylating drugs, antimetabolites, antibiotic antineoplastics,antineoplastics that alter hormone balance, and miscellaneousantineoplastics. The immunomodulation drug can be at least one selectedfrom immunosuppressants, vaccines or at least one toxoid, antitoxin orat least one antivenin, immune serum, and biological response modifier.The ophthalmic, otic, and nasal drugs can be at least one selected fromophthalmic anti-infectives, ophthalmic anti-inflammatories, miotics,mydriatics, ophthalmic vasoconstrictors, miscellaneous ophthalmics,otics, and nasal drugs. The topical drug can be at least one selectedfrom local anti-infectives, scabicides or at least one pediculicide ortopical corticosteroid. The nutritional drug can be at least oneselected from vitamins, minerals, or calorics. See, e.g., contents ofNursing 2001 Drug Handbook, supra.

The at least one amebicide or antiprotozoal can be at least one selectedfrom atovaquone, chloroquine hydrochloride, chloroquine phosphate,metronidazole, metronidazole hydrochloride, and pentamidine isethionate.The at least one anthelmintic can be at least one selected frommebendazole, pyrantel pamoate, and thiabendazole. The at least oneantifungal can be at least one selected from amphotericin B,amphotericin B cholesteryl sulfate complex, amphotericin B lipidcomplex, amphotericin B liposomal, fluconazole, flucytosine,griseofulvin microsize, griseofulvin ultramicrosize, itraconazole,ketoconazole, nystatin, and terbinafine hydrochloride. The at least oneantimalarial can be at least one selected from chloroquinehydrochloride, chloroquine phosphate, doxycycline, hydroxychloroquinesulfate, mefloquine hydrochloride, primaquine phosphate, pyrimethamine,and pyrimethamine with sulfadoxine. The at least one antituberculotic orantileprotic can be at least one selected from clofazimine, cycloserine,dapsone, ethambutol hydrochloride, isoniazid, pyrazinamide, rifabutin,rifampin, rifapentine, and streptomycin sulfate. The at least oneaminoglycoside can be at least one selected from amikacin sulfate,gentamicin sulfate, neomycin sulfate, streptomycin sulfate, andtobramycin sulfate. The at least one penicillin can be at least oneselected from amoxcillin/clavulanate potassium, amoxicillin trihydrate,ampicillin, ampicillin sodium, ampicillin trihydrate, ampicillinsodium/sulbactam sodium, cloxacillin sodium, dicloxacillin sodium,mezlocillin sodium, nafcillin sodium, oxacillin sodium, penicillin Gbenzathine, penicillin G potassium, penicillin G procaine, penicillin Gsodium, penicillin V potassium, piperacillin sodium, piperacillinsodium/tazobactam sodium, ticarcillin disodium, and ticarcillindisodium/clavulanate potassium. The at least one cephalosporin can be atleast one selected from cefaclor, cefadroxil, cefazolin sodium,cefdinir, cefepime hydrochloride, cefixime, cefmetazole sodium,cefonicid sodium, cefoperazone sodium, cefotaxime sodium, cefotetandisodium, cefoxitin sodium, cefpodoxime proxetil, cefprozil,ceftazidime, ceftibuten, ceftizoxime sodium, ceftriaxone sodium,cefuroxime axetil, cefuroxime sodium, cephalexin hydrochloride,cephalexin monohydrate, cephradine, and loracarbef. The at least onetetracycline can be at least one selected from demeclocyclinehydrochloride, doxycycline calcium, doxycycline hyclate, doxycyclinehydrochloride, doxycycline monohydrate, minocycline hydrochloride, andtetracycline hydrochloride. The at least one sulfonamide can be at leastone selected from co-trimoxazole, sulfadiazine, sulfamethoxazole,sulfisoxazole, and sulfisoxazole acetyl. The at least onefluoroquinolone can be at least one selected from alatrofloxacinmesylate, ciprofloxacin, enoxacin, levofloxacin, lomefloxacinhydrochloride, nalidixic acid, norfloxacin, ofloxacin, sparfloxacin, andtrovafloxacin mesylate. The at least one fluoroquinolone can be at leastone selected from alatrofloxacin mesylate, ciprofloxacin, enoxacin,levofloxacin, lomefloxacin hydrochloride, nalidixic acid, norfloxacin,ofloxacin, sparfloxacin, and trovafloxacin mesylate. The at least oneantiviral can be at least one selected from abacavir sulfate, acyclovirsodium, amantadine hydrochloride, amprenavir, cidofovir, delavirdinemesylate, didanosine, efavirenz, famciclovir, fomivirsen sodium,foscarnet sodium, ganciclovir, indinavir sulfate, lamivudine,lamivudine/zidovudine, nelfinavir mesylate, nevirapine, oseltamivirphosphate, ribavirin, rimantadine hydrochloride, ritonavir, saquinavir,saquinavir mesylate, stavudine, valacyclovir hydrochloride, zalcitabine,zanamivir, and zidovudine. The at least one macroline anti-infective canbe at least one selected from azithromycin, clarithromycin,dirithromycin, erythromycin base, erythromycin estolate, erythromycinethylsuccinate, erythromycin lactobionate, and erythromycin stearate.The at least one miscellaneous anti-infective can be at least oneselected from aztreonam, bacitracin, chloramphenicol sodium sucinate,clindamycin hydrochloride, clindamycin palmitate hydrochloride,clindamycin phosphate, imipenem and cilastatin sodium, meropenem,nitrofurantoin macrocrystals, nitrofurantoin microcrystals,quinupristin/dalfopristin, spectinomycin hydrochloride, trimethoprim,and vancomycin hydrochloride. (See, e.g., pp. 24-214 of Nursing 2001Drug Handbook.)

The at least one inotropic can be at least one selected from amrinonelactate, digoxin, and milrinone lactate. The at least one antiarrhythmiccan be at least one selected from adenosine, amiodarone hydrochloride,atropine sulfate, bretylium tosylate, diltiazem hydrochloride,disopyramide, disopyramide phosphate, esmolol hydrochloride, flecainideacetate, ibutilide fumarate, lidocaine hydrochloride, mexiletinehydrochloride, moricizine hydrochloride, phenytoin, phenytoin sodium,procainamide hydrochloride, propafenone hydrochloride, propranololhydrochloride, quinidine bisulfate, quinidine gluconate, quinidinepolygalacturonate, quinidine sulfate, sotalol, tocainide hydrochloride,and verapamil hydrochloride. The at least one antianginal can be atleast one selected from amlodipidine besylate, amyl nitrite, bepridilhydrochloride, diltiazem hydrochloride, isosorbide dinitrate, isosorbidemononitrate, nadolol, nicardipine hydrochloride, nifedipine,nitroglycerin, propranolol hydrochloride, verapamil, and verapamilhydrochloride. The at least one antihypertensive can be at least oneselected from acebutolol hydrochloride, amlodipine besylate, atenolol,benazepril hydrochloride, betaxolol hydrochloride, bisoprolol fumarate,candesartan cilexetil, captopril, carteolol hydrochloride, carvedilol,clonidine, clonidine hydrochloride, diazoxide, diltiazem hydrochloride,doxazosin mesylate, enalaprilat, enalapril maleate, eprosartan mesylate,felodipine, fenoldopam mesylate, fosinopril sodium, guanabenz acetate,guanadrel sulfate, guanfacine hydrochloride, hydralazine hydrochloride,irbesartan, isradipine, labetalol hydrochloride, lisinopril, losartanpotassium, methyldopa, methyldopate hydrochloride, metoprolol succinate,metoprolol tartrate, minoxidil, moexipril hydrochloride, nadolol,nicardipine hydrochloride, nifedipine, nisoldipine, nitroprussidesodium, penbutolol sulfate, perindopril erbumine, phentolamine mesylate,pindolol, prazosin hydrochloride, propranolol hydrochloride, quinaprilhydrochloride, ramipril, telmisartan, terazosin hydrochloride, timololmaleate, trandolapril, valsartan, and verapamil hydrochloride. The atleast one antilipemic can be at least one selected from atorvastatincalcium, cerivastatin sodium, cholestyramine, colestipol hydrochloride,fenofibrate (micronized), fluvastatin sodium, gemfibrozil, lovastatin,niacin, pravastatin sodium, and simvastatin. The at least onemiscellaneous CV drug can be at least one selected from abciximab,alprostadil, arbutamine hydrochloride, cilostazol, clopidogrelbisulfate, dipyridamole, eptifibatide, midodrine hydrochloride,pentoxifylline, ticlopidine hydrochloride, and tirofiban hydrochloride.(See, e.g., pp. 215-336 of Nursing 2001 Drug Handbook.)

The at least one nonnarcotic analgesic or antipyretic can be at leastone selected from acetaminophen, aspirin, choline magnesiumtrisalicylate, diflunisal, and magnesium salicylate. The at least onenonsteroidal anti-inflammatory drug can be at least one selected fromcelecoxib, diclofenac potassium, diclofenac sodium, etodolac, fenoprofencalcium, flurbiprofen, ibuprofen, indomethacin, indomethacin sodiumtrihydrate, ketoprofen, ketorolac tromethamine, nabumetone, naproxen,naproxen sodium, oxaprozin, piroxicam, rofecoxib, and sulindac. The atleast one narcotic or opioid analgesic can be at least one selected fromalfentanil hydrochloride, buprenorphine hydrochloride, butorphanoltartrate, codeine phosphate, codeine sulfate, fentanyl citrate, fentanyltransdermal system, fentanyl transmucosal, hydromorphone hydrochloride,meperidine hydrochloride, methadone hydrochloride, morphinehydrochloride, morphine sulfate, morphine tartrate, nalbuphinehydrochloride, oxycodone hydrochloride, oxycodone pectinate, oxymorphonehydrochloride, pentazocine hydrochloride, pentazocine hydrochloride andnaloxone hydrochloride, pentazocine lactate, propoxyphene hydrochloride,propoxyphene napsylate, remifentanil hydrochloride, sufentanil citrate,and tramadol hydrochloride. The at least one sedative-hypnotic can be atleast one selected from chloral hydrate, estazolam, flurazepamhydrochloride, pentobarbital, pentobarbital sodium, phenobarbitalsodium, secobarbital sodium, temazepam, triazolam, zaleplon, andzolpidem tartrate. The at least one anticonvulsant can be at least oneselected from acetazolamide sodium, carbamazepine, clonazepam,clorazepate dipotassium, diazepam, divalproex sodium, ethosuximde,fosphenytoin sodium, gabapentin, lamotrigine, magnesium sulfate,phenobarbital, phenobarbital sodium, phenytoin, phenytoin sodium,phenytoin sodium (extended), primidone, tiagabine hydrochloride,topiramate, valproate sodium, and valproic acid. The at least oneantidepressant can be at least one selected from amitriptylinehydrochloride, amitriptyline pamoate, amoxapine, bupropionhydrochloride, citalopram hydrobromide, clomipramine hydrochloride,desipramine hydrochloride, doxepin hydrochloride, fluoxetinehydrochloride, imipramine hydrochloride, imipramine pamoate,mirtazapine, nefazodone hydrochloride, nortriptyline hydrochloride,paroxetine hydrochloride, phenelzine sulfate, sertraline hydrochloride,tranylcypromine sulfate, trimipramine maleate, and venlafaxinehydrochloride. The at least one antianxiety drug can be at least oneselected from alprazolam, buspirone hydrochloride, chlordiazepoxide,chlordiazepoxide hydrochloride, clorazepate dipotassium, diazepam,doxepin hydrochloride, hydroxyzine embonate, hydroxyzine hydrochloride,hydroxyzine pamoate, lorazepam, mephrobamate, midazolam hydrochloride,and oxazepam. The at least one antipsychotic drug can be at least oneselected from chlorpromazine hydrochloride, clozapine, fluphenazinedecanoate, fluephenazine enanthate, fluphenazine hydrochloride,haloperidol, haloperidol decanoate, haloperidol lactate, loxapinehydrochloride, loxapine succinate, mesoridazine besylate, molindonehydrochloride, olanzapine, perphenazine, pimozide, prochlorperazine,quetiapine fumarate, risperidone, thioridazine hydrochloride,thiothixene, thiothixene hydrochloride, and trifluoperazinehydrochloride. The at least one central nervous system stimulant can beat least one selected from amphetamine sulfate, caffeine,dextroamphetamine sulfate, doxapram hydrochloride, methamphetaminehydrochloride, methylphenidate hydrochloride, modafinil, pemoline, andphentermine hydrochloride. The at least one antiparkinsonian can be atleast one selected from amantadine hydrochloride, benztropine mesylate,biperiden hydrochloride, biperiden lactate, bromocriptine mesylate,carbidopa-levodopa, entacapone, levodopa, pergolide mesylate,pramipexole dihydrochloride, ropinirole hydrochloride, selegilinehydrochloride, tolcapone, and trihexyphenidyl hydrochloride. The atleast one miscellaneous central nervous system drug can be at least oneselected from bupropion hydrochloride, donepezil hydrochloride,droperidol, fluvoxamine maleate, lithium carbonate, lithium citrate,naratriptan hydrochloride, nicotine polacrilex, nicotine transdermalsystem, propofol, rizatriptan benzoate, sibutramine hydrochloridemonohydrate, sumatriptan succinate, tacrine hydrochloride, andzolmitriptan. (See, e.g., pp. 337-530 of Nursing 2001 Drug Handbook.)

The at least one cholinergic (e.g., parasymathomimetic) can be at leastone selected from bethanechol chloride, edrophonium chloride,neostigmine bromide, neostigmine methylsulfate, physostigminesalicylate, and pyridostigmine bromide. The at least one anticholinergiccan be at least one selected from atropine sulfate, dicyclominehydrochloride, glycopyrrolate, hyoscyamine, hyoscyamine sulfate,propantheline bromide, scopolamine, scopolamine butylbromide, andscopolamine hydrobromide. The at least one adrenergic (sympathomimetics)can be at least one selected from dobutamine hydrochloride, dopaminehydrochloride, metaraminol bitartrate, norepinephrine bitartrate,phenylephrine hydrochloride, pseudoephedrine hydrochloride, andpseudoephedrine sulfate. The at least one adrenergic blocker(sympatholytic) can be at least one selected from dihydroergotaminemesylate, ergotamine tartrate, methysergide maleate, and propranololhydrochloride. The at least one skeletal muscle relaxant can be at leastone selected from baclofen, carisoprodol, chlorzoxazone, cyclobenzaprinehydrochloride, dantrolene sodium, methocarbamol, and tizanidinehydrochloride. The at least one neuromuscular blocker can be at leastone selected from atracurium besylate, cisatracurium besylate,doxacurium chloride, mivacurium chloride, pancuronium bromide,pipecuronium bromide, rapacuronium bromide, rocuronium bromide,succinylcholine chloride, tubocurarine chloride, and vecuronium bromide.(See, e.g., pp. 531-84 of Nursing 2001 Drug Handbook.)

The at least one antihistamine can be at least one selected frombrompheniramine maleate, cetirizine hydrochloride, chlorpheniraminemaleate, clemastine fumarate, cyproheptadine hydrochloride,diphenhydramine hydrochloride, fexofenadine hydrochloride, loratadine,promethazine hydrochloride, promethazine theoclate, and triprolidinehydrochloride. The at least one bronchodilator can be at least oneselected from albuterol, albuterol sulfate, aminophylline, atropinesulfate, ephedrine sulfate, epinephrine, epinephrine bitartrate,epinephrine hydrochloride, ipratropium bromide, isoproterenol,isoproterenol hydrochloride, isoproterenol sulfate, levalbuterolhydrochloride, metaproterenol sulfate, oxtriphylline, pirbuterolacetate, salmeterol xinafoate, terbutaline sulfate, and theophylline.The at least one expectorant or antitussive can be at least one selectedfrom benzonatate, codeine phosphate, codeine sulfate, dextramethorphanhydrobromide, diphenhydramine hydrochloride, guaifenesin, andhydromorphone hydrochloride. The at least one miscellaneous respiratorydrug can be at least one selected from acetylcysteine, beclomethasonedipropionate, beractant, budesonide, calfactant, cromolyn sodium,dornase alfa, epoprostenol sodium, flunisolide, fluticasone propionate,montelukast sodium, nedocromil sodium, palivizumab, triamcinoloneacetonide, zafirlukast, and zileuton. (See, e.g., pp. 585-642 of Nursing2001 Drug Handbook.)

The at least one antacid, adsorbent, or antiflatulent can be at leastone selected from aluminum carbonate, aluminum hydroxide, calciumcarbonate, magaldrate, magnesium hydroxide, magnesium oxide,simethicone, and sodium bicarbonate. The at least one digestive enzymeor gallstone solubilizer can be at least one selected from pancreatin,pancrelipase, and ursodiol. The at least one antidiarrheal can be atleast one selected from attapulgite, bismuth subsalicylate, calciumpolycarbophil, diphenoxylate hydrochloride and atropine sulfate,loperamide, octreotide acetate, opium tincture, and opium tincure(camphorated). The at least one laxative can be at least one selectedfrom bisocodyl, calcium polycarbophil, cascara sagrada, cascara sagradaaromatic fluidextract, cascara sagrada fluidextract, castor oil,docusate calcium, docusate sodium, glycerin, lactulose, magnesiumcitrate, magnesium hydroxide, magnesium sulfate, methylcellulose,mineral oil, polyethylene glycol or electrolyte solution, psyllium,senna, and sodium phosphates. The at least one antiemetic can be atleast one selected from chlorpromazine hydrochloride, dimenhydrinate,dolasetron mesylate, dronabinol, granisetron hydrochloride, meclizinehydrochloride, metocloproamide hydrochloride, ondansetron hydrochloride,perphenazine, prochlorperazine, prochlorperazine edisylate,prochlorperazine maleate, promethazine hydrochloride, scopolamine,thiethylperazine maleate, and trimethobenzamide hydrochloride. The atleast one antiulcer drug can be at least one selected from cimetidine,cimetidine hydrochloride, famotidine, lansoprazole, misoprostol,nizatidine, omeprazole, rabeprozole sodium, rantidine bismuth citrate,ranitidine hydrochloride, and sucralfate. (See, e.g., pp. 643-95 ofNursing 2001 Drug Handbook.)

The at least one corticosteroid can be at least one selected frombetamethasone, betamethasone acetate or betamethasone sodium phosphate,betamethasone sodium phosphate, cortisone acetate, dexamethasone,dexamethasone acetate, dexamethasone sodium phosphate, fludrocortisoneacetate, hydrocortisone, hydrocortisone acetate, hydrocortisonecypionate, hydrocortisone sodium phosphate, hydrocortisone sodiumsuccinate, methylprednisolone, methylprednisolone acetate,methylprednisolone sodium succinate, prednisolone, prednisolone acetate,prednisolone sodium phosphate, prednisolone tebutate, prednisone,triamcinolone, triamcinolone acetonide, and triamcinolone diacetate. Theat least one androgen or anabolic steroid can be at least one selectedfrom danazol, fluoxymesterone, methyltestosterone, nandrolone decanoate,nandrolone phenpropionate, testosterone, testosterone cypionate,testosterone enanthate, testosterone propionate, and testosteronetransdermal system. The at least one estrogen or progestin can be atleast one selected from esterified estrogens, estradiol, estradiolcypionate, estradiol/norethindrone acetate transdermal system, estradiolvalerate, estrogens (conjugated), estropipate, ethinyl estradiol,ethinyl estradiol and desogestrel, ethinyl estradiol and ethynodioldiacetate, ethinyl estradiol and desogestrel, ethinyl estradiol andethynodiol diacetate, ethinyl estradiol and levonorgestrel, ethinylestradiol and norethindrone, ethinyl estradiol and norethindroneacetate, ethinyl estradiol and norgestimate, ethinyl estradiol andnorgestrel, ethinyl estradiol and norethindrone and acetate and ferrousfumarate, levonorgestrel, medroxyprogesterone acetate, mestranol andnorethindron, norethindrone, norethindrone acetate, norgestrel, andprogesterone. The at least one gonadroptropin can be at least oneselected from ganirelix acetate, gonadoreline acetate, histrelinacetate, and menotropins. The at least one antidiabetic or glucaon canbe at least one selected from acarbose, chlorpropamide, glimepiride,glipizide, glucagon, glyburide, insulins, metformin hydrochloride,miglitol, pioglitazone hydrochloride, repaglinide, rosiglitazonemaleate, and troglitazone. The at least one thyroid hormone can be atleast one selected from levothyroxine sodium, liothyronine sodium,liotrix, and thyroid. The at least one thyroid hormone antagonist can beat least one selected from methimazole, potassium iodide, potassiumiodide (saturated solution), propylthiouracil, radioactive iodine(sodium iodide ¹³¹I), and strong iodine solution. The at least onepituitary hormone can be at least one selected from corticotropin,cosyntropin, desmophressin acetate, leuprolide acetate, repositorycorticotropin, somatrem, somatropin, and vasopressin. The at least oneparathyroid-like drug can be at least one selected from calcifediol,calcitonin (human), calcitonin (salmon), calcitriol, dihydrotachysterol,and etidronate disodium. (See, e.g., pp. 696-796 of Nursing 2001 DrugHandbook.)

The at least one diuretic can be at least one selected fromacetazolamide, acetazolamide sodium, amiloride hydrochloride,bumetanide, chlorthalidone, ethacrynate sodium, ethacrynic acid,furosemide, hydrochlorothiazide, indapamide, mannitol, metolazone,spironolactone, torsemide, triamterene, and urea. The at least oneelectrolyte or replacement solution can be at least one selected fromcalcium acetate, calcium carbonate, calcium chloride, calcium citrate,calcium glubionate, calcium gluceptate, calcium gluconate, calciumlactate, calcium phosphate (dibasic), calcium phosphate (tribasic),dextran (high-molecular-weight), dextran (low-molecular-weight),hetastarch, magnesium chloride, magnesium sulfate, potassium acetate,potassium bicarbonate, potassium chloride, potassium gluconate, Ringer'sinjection, Ringer's injection (lactated), and sodium chloride. The atleast one acidifier or alkalinizer can be at least one selected fromsodium bicarbonate, sodium lactate, and tromethamine. (See, e.g., pp.797-833 of Nursing 2001 Drug Handbook.)

The at least one hematinic can be at least one selected from ferrousfumarate, ferrous gluconate, ferrous sulfate, ferrous sulfate (dried),iron dextran, iron sorbitol, polysaccharide-iron complex, and sodiumferric gluconate complex. The at least one anticoagulant can be at leastone selected from ardeparin sodium, dalteparin sodium, danaparoidsodium, enoxaparin sodium, heparin calcium, heparin sodium, and warfarinsodium. The at least one blood derivative can be at least one selectedfrom albumin 5%, albumin 25%, antihemophilic factor, anti-inhibitorcoagulant complex, antithrombin III (human), factor IX (human), factorIX complex, and plasma protein fractions. The at least one thrombolyticenzyme can be at least one selected from alteplase, anistreplase,reteplase (recombinant), streptokinase, and urokinase. (See, e.g., pp.834-66 of Nursing 2001 Drug Handbook.)

The at least one alkylating drug can be at least one selected frombusulfan, carboplatin, carmustine, chlorambucil, cisplatin,cyclophosphamide, ifosfamide, lomustine, mechlorethamine hydrochloride,melphalan, melphalan hydrochloride, streptozocin, temozolomide, andthiotepa. The at least one antimetabolite can be at least one selectedfrom capecitabine, cladribine, cytarabine, floxuridine, fludarabinephosphate, fluorouracil, hydroxyurea, mercaptopurine, methotrexate,methotrexate sodium, and thioguanine. The at least one antibioticantineoplastic can be at least one selected from bleomycin sulfate,dactinomycin, daunorubicin citrate liposomal, daunorubicinhydrochloride, doxorubicin hydrochloride, doxorubicin hydrochlorideliposomal, epirubicin hydrochloride, idarubicin hydrochloride,mitomycin, pentostatin, plicamycin, and valrubicin. The at least oneantineoplastic that alters hormone balance can be at least one selectedfrom anastrozole, bicalutamide, estramustine phosphate sodium,exemestane, flutamide, goserelin acetate, letrozole, leuprolide acetate,megestrol acetate, nilutamide, tamoxifen citrate, testolactone, andtoremifene citrate. The at least one miscellaneous antineoplastic can beat least one selected from asparaginase, bacillus Calmette-Guerin (BCG)(live intravesical), dacarbazine, docetaxel, etoposide, etoposidephosphate, gemcitabine hydrochloride, irinotecan hydrochloride,mitotane, mitoxantrone hydrochloride, paclitaxel, pegaspargase, porfimersodium, procarbazine hydrochloride, rituximab, teniposide, topotecanhydrochloride, trastuzumab, tretinoin, vinblastine sulfate, vincristinesulfate, and vinorelbine tartrate. (See, e.g., pp. 867-963 of Nursing2001 Drug Handbook.)

The at least one immunosuppressant can be at least one selected fromazathioprine, basiliximab, cyclosporine, daclizumab, lymphocyte immuneglobulin, muromonab-CD3, mycophenolate mofetil, mycophenolate mofetilhydrochloride, sirolimus, and tacrolimus. The at least one vaccine ortoxoid can be at least one selected from BCG vaccine, cholera vaccine,diphtheria and tetanus toxoids (adsorbed), diphtheria and tetanustoxoids and acellular pertussis vaccine adsorbed, diphtheria and tetanustoxoids and whole-cell pertussis vaccine, Haemophilius b conjugatevaccines, hepatitis A vaccine (inactivated), hepatisis B vaccine(recombinant), influenza virus vaccine 1999-2000 trivalent types A & B(purified surface antigen), influenza virus vaccine 1999-2000 trivalenttypes A & B (subvirion or purified subvirion), influenza virus vaccine1999-2000 trivalent types A & B (whole virion), Japanese encephalitisvirus vaccine (inactivated), Lyme disease vaccine (recombinant OspA),measles and mumps and rubella virus vaccine (live), measles and mumpsand rubella virus vaccine (live attenuated), measles virus vaccine (liveattenuated), meningococcal polysaccharide vaccine, mumps virus vaccine(live), plague vaccine, pneumococcal vaccine (polyvalent), poliovirusvaccine (inactivated), poliovirus vaccine (live, oral, trivalent),rabies vaccine (adsorbed), rabies vaccine (human diploid cell), rubellaand mumps virus vaccine (live), rubella virus vaccine (live,attenuated), tetanus toxoid (adsorbed), tetanus toxoid (fluid), typhoidvaccine (oral), typhoid vaccine (parenteral), typhoid Vi polysaccharidevaccine, varicella virus vaccine, and yellow fever vaccine. The at leastone antitoxin or antivenin can be at least one selected from black widowspider antivenin, Crotalidae antivenom (polyvalent), diphtheriaantitoxin (equine), amd Micrurus fulvius antivenin. The at least oneimmune serum can be at least one selected from cytomegalovirus immuneglobulin (intraveneous), hepatitis B immune globulin (human), immuneglobulin intramuscular, immune globulin intravenous, rabies immuneglobulin (human), respiratory syncytial virus immune globulinintravenous (human), Rho(D) immune globulin (human), Rho(D) immuneglobulin intravenous (human), tetanus immune globulin (human), andvaricella-zoster immune globulin. The at least one biological responsemodifier can be at least one selected from aldesleukin, epoetin alfa,filgrastim, glatiramer acetate for injection, interferon alfacon-1,interferon alfa-2a (recombinant), interferon alfa-2b (recombinant),interferon beta-1a, interferon beta-1b (recombinant), interferongamma-1b, levamisole hydrochloride, oprelvekin, and sargramostim. (See,e.g., pp. 964-1040 of Nursing 2001 Drug Handbook.)

The at least one ophthalmic anti-infective can be selected formbacitracin, chloramphenicol, ciprofloxacin hydrochloride, erythromycin,gentamicin sulfate, ofloxacin 0.3%, polymyxin B sulfate, sulfacetamidesodium 10%, sulfacetamide sodium 15%, sulfacetamide sodium 30%,tobramycin, and vidarabine. The at least one ophthalmicanti-inflammatory can be at least one selected from dexamethasone,dexamethasone sodium phosphate, diclofenac sodium 0.1%, fluorometholone,flurbiprofen sodium, ketorolac tromethamine, prednisolone acetate(suspension) and prednisolone sodium phosphate (solution). The at leastone miotic can be at least one selected from acetylocholine chloride,carbachol (intraocular), carbachol (topical), echothiophate iodide,pilocarpine, pilocarpine hydrochloride, and pilocarpine nitrate. The atleast one mydriatic can be at least one selected from atropine sulfate,cyclopentolate hydrochloride, epinephrine hydrochloride, epinephrylborate, homatropine hydrobromide, phenylephrine hydrochloride,scopolamine hydrobromide, and tropicamide. The at least one ophthalmicvasoconstrictor can be at least one selected from naphazolinehydrochloride, oxymetazoline hydrochloride, and tetrahydrozolinehydrochloride. The at least one miscellaneous ophthalmic can be at leastone selected from apraclonidine hydrochloride, betaxolol hydrochloride,brimonidine tartrate, carteolol hydrochloride, dipivefrin hydrochloride,dorzolamide hydrochloride, emedastine difumarate, fluorescein sodium,ketotifen fumarate, latanoprost, levobunolol hydrochloride, metipranololhydrochloride, sodium chloride (hypertonic), and timolol maleate. The atleast one otic can be at least one selected from boric acid, carbamideperoxide, chloramphenicol, and triethanolamine polypeptideoleate-condensate. The at least one nasal drug can be at least oneselected from beclomethasone dipropionate, budesonide, ephedrinesulfate, epinephrine hydrochloride, flunisolide, fluticasone propionate,naphazoline hydrochloride, oxymetazoline hydrochloride, phenylephrinehydrochloride, tetrahydrozoline hydrochloride, triamcinolone acetonide,and xylometazoline hydrochloride. (See, e.g., pp. 1041-97 of Nursing2001 Drug Handbook.)

The at least one local anti-infective can be at least one selected fromacyclovir, amphotericin B, azelaic acid cream, bacitracin, butoconazolenitrate, clindamycin phosphate, clotrimazole, econazole nitrate,erythromycin, gentamicin sulfate, ketoconazole, mafenide acetate,metronidazole (topical), miconazole nitrate, mupirocin, naftifinehydrochloride, neomycin sulfate, nitrofurazone, nystatin, silversulfadiazine, terbinafine hydrochloride, terconazole, tetracyclinehydrochloride, tioconazole, and tolnaftate. The at least one scabicideor pediculicide can be at least one selected from crotamiton, lindane,permethrin, and pyrethrins. The at least one topical corticosteroid canbe at least one selected from betamethasone dipropionate, betamethasonevalerate, clobetasol propionate, desonide, desoximetasone,dexamethasone, dexamethasone sodium phosphate, diflorasone diacetate,fluocinolone acetonide, fluocinonide, flurandrenolide, fluticasonepropionate, halcionide, hydrocortisone, hydrocortisone acetate,hydrocortisone butyrate, hydrocorisone valerate, mometasone furoate, andtriamcinolone acetonide. (See, e.g., pp. 1098-1136 of Nursing 2001 DrugHandbook.)

The at least one vitamin or mineral can be at least one selected fromvitamin A, vitamin B complex, cyanocobalamin, folic acid,hydroxocobalamin, leucovorin calcium, niacin, niacinamide, pyridoxinehydrochloride, riboflavin, thiamine hydrochloride, vitamin C, vitamin D,cholecalciferol, ergocalciferol, vitamin D analogue, doxercalciferol,paricalcitol, vitamin E, vitamin K analogue, phytonadione, sodiumfluoride, sodium fluoride (topical), trace elements, chromium, copper,iodine, manganese, selenium, and zinc. The at least one caloric can beat least one selected from amino acid infusions (crystalline), aminoacid infusions in dextrose, amino acid infusions with electrolytes,amino acid infusions with electrolytes in dextrose, amino acid infusionsfor hepatic failure, amino acid infusions for high metabolic stress,amino acid infusions for renal failure, dextrose, fat emulsions, andmedium-chain triglycerides. (See, e.g., pp. 1137-63 of Nursing 2001 DrugHandbook.)

Anti-IL-6 antibody compositions of the present invention can furthercomprise at least one of any suitable and effective amount of acomposition or pharmaceutical composition comprising at least oneanti-IL-6 antibody contacted or administered to a cell, tissue, organ,animal or patient in need of such modulation, treatment or therapy,optionally further comprising at least one selected from at least oneTNF antagonist (e.g., but not limited to a TNF chemical or proteinantagonist, TNF monoclonal or polyclonal antibody or fragment, a solubleTNF receptor (e.g., p55, p70 or p85) or fragment, fusion polypeptidesthereof, or a small molecule TNF antagonist, e.g., TNF binding protein Ior II (TBP-1 or TBP-II), nerelimonmab, infliximab, etanercept, CDP-571,CDP-870, afelimomab, lenercept, and the like), an antirheumatic (e.g.,methotrexate, auranofin, aurothioglucose, azathioprine, etanercept, goldsodium thiomalate, hydroxychloroquine sulfate, leflunomide,sulfasalzine), a muscle relaxant, a narcotic, a non-steroidanti-inflammatory drug (NSAID), an analgesic, an anesthetic, a sedative,a local anethetic, a neuromuscular blocker, an antimicrobial (e.g.,aminoglycoside, an antifungal, an antiparasitic, an antiviral, acarbapenem, cephalosporin, a flurorquinolone, a macrolide, a penicillin,a sulfonamide, a tetracycline, another antimicrobial), an antipsoriatic,a corticosteriod, an anabolic steroid, a diabetes related agent, amineral, a nutritional, a thyroid agent, a vitamin, a calcium relatedhormone, an antidiarrheal, an antitussive, an antiemetic, an antiulcer,a laxative, an anticoagulant, an erythropoietin (e.g., epoetin alpha), afilgrastim (e.g., G-CSF, Neupogen), a sargramostim (GM-CSF, Leukine), animmunization, an immunoglobulin, an immunosuppressive (e.g.,basiliximab, cyclosporine, daclizumab), a growth hormone, a hormonereplacement drug, an estrogen receptor modulator, a mydriatic, acycloplegic, an alkylating agent, an antimetabolite, a mitoticinhibitor, a radiopharmaceutical, an antidepressant, antimanic agent, anantipsychotic, an anxiolytic, a hypnotic, a sympathomimetic, astimulant, donepezil, tacrine, an asthma medication, a beta agonist, aninhaled steroid, a leukotriene inhibitor, a methylxanthine, a cromolyn,an epinephrine or analog, dornase alpha (Pulmozyme), a cytokine or acytokine antagonist. Non-limiting examples of such cytokines include,but are not limited to, any of IL-1 to IL-23 (e.g., IL-1, IL-2, etc.).Suitable dosages are well known in the art. See, e.g., Wells et al.,eds., Pharmacotherapy Handbook, 2^(nd) Edition, Appleton and Lange,Stamford, Conn. (2000); PDR Pharmacopoeia, Tarascon Pocket Pharmacopoeia2000, Deluxe Edition, Tarascon Publishing, Loma Linda, Calif. (2000),each of which references are entirely incorporated herein by reference.

Such anti-cancer or anti-infectives can also include toxin moleculesthat are associated, bound, co-formulated or co-administered with atleast one antibody of the present invention. The toxin can optionallyact to selectively kill the pathologic cell or tissue. The pathologiccell can be a cancer or other cell. Such toxins can be, but are notlimited to, purified or recombinant toxin or toxin fragment comprisingat least one functional cytotoxic domain of toxin, e.g., selected fromat least one of ricin, diphtheria toxin, a venom toxin, or a bacterialtoxin. The term toxin also includes both endotoxins and exotoxinsproduced by any naturally occurring, mutant or recombinant bacteria orviruses which may cause any pathological condition in humans and othermammals, including toxin shock, which can result in death. Such toxinsmay include, but are not limited to, enterotoxigenic E. coli heat-labileenterotoxin (LT), heat-stable enterotoxin (ST), Shigella cytotoxin,Aeromonas enterotoxins, toxic shock syndrome toxin-1 (TSST-1),Staphylococcal enterotoxin A (SEA), B (SEB), or C (SEC), Streptococcalenterotoxins and the like. Such bacteria include, but are not limitedto, strains of a species of enterotoxigenic E. coli (ETEC),enterohemorrhagic E. coli (e.g., strains of serotype O157:H7),Staphylococcus species (e.g., Staphylococcus aureus, Staphylococcuspyogenes), Shigella species (e.g., Shigella dysenteriae, Shigellaflexneri, Shigella boydii, and Shigella sonnei), Salmonella species(e.g., Salmonella typhi, Salmonella cholera-suis, Salmonellaenteritidis), Clostridium species (e.g., Clostridium perfringens,Clostridium difficile, Clostridium botulinum), Camphlobacter species(e.g., Camphlobacter jejuni, Camphlobacter fetus), Heliobacter species,(e.g., Heliobacter pylori), Aeromonas species (e.g., Aeromonas sobria,Aeromonas hydrophila, Aeromonas caviae), Pleisomonas shigelloides,Yersina enterocolitica, Vibrios species (e.g., Vibrios cholerae, Vibriosparahemolyticus), Klebsiella species, Pseudomonas aeruginosa, andStreptococci. See, e.g., Stein, ed., INTERNAL MEDICINE, 3rd ed., pp1-13, Little, Brown and Co., Boston, (1990); Evans et al., eds.,Bacterial Infections of Humans: Epidemiology and Control, 2d. Ed., pp239-254, Plenum Medical Book Co., New York (1991); Mandell et al,Principles and Practice of Infectious Diseases, 3d. Ed., ChurchillLivingstone, N.Y. (1990); Berkow et al, eds., The Merck Manual, 16thedition, Merck and Co., Rahway, N.J., 1992; Wood et al, FEMSMicrobiology Immunology, 76:121-134 (1991); Marrack et al, Science,248:705-711 (1990), the contents of which references are incorporatedentirely herein by reference.

Anti-IL-6 antibody compounds, compositions or combinations of thepresent invention can further comprise at least one of any suitableauxiliary, such as, but not limited to, diluent, binder, stabilizer,buffers, salts, lipophilic solvents, preservative, adjuvant or the like.Pharmaceutically acceptable auxiliaries are preferred. Non-limitingexamples of, and methods of preparing such sterile solutions are wellknown in the art, such as, but limited to, Gennaro, Ed., Remington'sPharmaceutical Sciences, 18^(th) Edition, Mack Publishing Co. (Easton,Pa.) 1990. Pharmaceutically acceptable carriers can be routinelyselected that are suitable for the mode of administration, solubilityand/or stability of the anti-IL-6 antibody, fragment or variantcomposition as well known in the art or as described herein.

Pharmaceutical excipients and additives useful in the presentcomposition include, but are not limited to, proteins, peptides, aminoacids, lipids, and carbohydrates (e.g., sugars, includingmonosaccharides, di-, tri-, tetra-, and oligosaccharides; derivatizedsugars, such as alditols, aldonic acids, esterified sugars and the like;and polysaccharides or sugar polymers), which can be present singly orin combination, comprising alone or in combination 1-99.99% by weight orvolume. Exemplary protein excipients include serum albumin, such ashuman serum albumin (HSA), recombinant human albumin (rHA), gelatin,casein, and the like. Representative amino acid/antibody components,which can also function in a buffering capacity, include alanine,glycine, arginine, betaine, histidine, glutamic acid, aspartic acid,cysteine, lysine, leucine, isoleucine, valine, methionine,phenylalanine, aspartame, and the like. One preferred amino acid isglycine.

Carbohydrate excipients suitable for use in the invention include, forexample, monosaccharides, such as fructose, maltose, galactose, glucose,D-mannose, sorbose, and the like; disaccharides, such as lactose,sucrose, trehalose, cellobiose, and the like; polysaccharides, such asraffinose, melezitose, maltodextrins, dextrans, starches, and the like;and alditols, such as mannitol, xylitol, maltitol, lactitol, xylitolsorbitol (glucitol), myoinositol and the like. Preferred carbohydrateexcipients for use in the present invention are mannitol, trehalose, andraffinose.

Anti-IL-6 antibody compositions can also include a buffer or a pHadjusting agent; typically, the buffer is a salt prepared from anorganic acid or base. Representative buffers include organic acid salts,such as salts of citric acid, ascorbic acid, gluconic acid, carbonicacid, tartaric acid, succinic acid, acetic acid, or phthalic acid; Tris,tromethamine hydrochloride, or phosphate buffers. Preferred buffers foruse in the present compositions are organic acid salts, such as citrate.

Additionally, anti-IL-6 antibody compositions of the invention caninclude polymeric excipients/additives, such as polyvinylpyrrolidones,ficolls (a polymeric sugar), dextrates (e.g., cyclodextrins, such as2-hydroxypropyl-β-cyclodextrin), polyethylene glycols, flavoring agents,antimicrobial agents, sweeteners, antioxidants, antistatic agents,surfactants (e.g., polysorbates, such as “TWEEN 20” and “TWEEN 80”),lipids (e.g., phospholipids, fatty acids), steroids (e.g., cholesterol),and chelating agents (e.g., EDTA).

These and additional known pharmaceutical excipients and/or additivessuitable for use in the anti-IL-6 antibody, portion or variantcompositions according to the invention are known in the art, e.g., aslisted in “Remington: The Science & Practice of Pharmacy”, 19^(th) ed.,Williams & Williams, (1995), and in the “Physician's Desk Reference”,52^(nd) ed., Medical Economics, Montvale, N.J. (1998), the disclosuresof which are entirely incorporated herein by reference. Preferredcarrier or excipient materials are carbohydrates (e.g., saccharides andalditols) and buffers (e.g., citrate) or polymeric agents. An exemplarycarrier molecule is the mucopolysaccharide, hyaluronic acid, which maybe useful for intraarticular delivery.

Formulations

As noted above, the invention provides for stable formulations, whichpreferably comprise a phosphate buffer with saline or a chosen salt, aswell as preserved solutions and formulations containing a preservativeas well as multi-use preserved formulations suitable for pharmaceuticalor veterinary use, comprising at least one anti-IL-6 antibody in apharmaceutically acceptable formulation. Preserved formulations containat least one known preservative or optionally selected from the groupconsisting of at least one phenol, m-cresol, p-cresol, o-cresol,chlorocresol, benzyl alcohol, phenylmercuric nitrite, phenoxyethanol,formaldehyde, chlorobutanol, magnesium chloride (e.g., hexahydrate),alkylparaben (methyl, ethyl, propyl, butyl and the like), benzalkoniumchloride, benzethonium chloride, sodium dehydroacetate and thimerosal,polymers, or mixtures thereof in an aqueous diluent. Any suitableconcentration or mixture can be used as known in the art, such as about0.0015%, or any range, value, or fraction therein. Non-limiting examplesinclude, no preservative, about 0.1-2% m-cresol (e.g., 0.2, 0.3. 0.4,0.5, 0.9, 1.0%), about 0.1-3% benzyl alcohol (e.g., 0.5, 0.9, 1.1, 1.5,1.9, 2.0, 2.5%), about 0.001-0.5% thimerosal (e.g., 0.005, 0.01), about0.001-2.0% phenol (e.g., 0.05, 0.25, 0.28, 0.5, 0.9, 1.0%), 0.0005-1.0%alkylparaben(s) (e.g., 0.00075, 0.0009, 0.001, 0.002, 0.005, 0.0075,0.009, 0.01, 0.02, 0.05, 0.075, 0.09, 0.1, 0.2, 0.3, 0.5, 0.75, 0.9,1.0%), and the like.

As noted above, the invention provides an article of manufacture,comprising packaging material and at least one vial comprising asolution of at least one anti-IL-6 antibody with the prescribed buffersand/or preservatives, optionally in an aqueous diluent, wherein saidpackaging material comprises a label that indicates that such solutioncan be held over a period of 1, 2, 3, 4, 5, 6, 9, 12, 18, 20, 24, 30,36, 40, 48, 54, 60, 66, 72 hours or greater. The invention furthercomprises an article of manufacture, comprising packaging material, afirst vial comprising lyophilized at least one anti-IL-6 antibody, and asecond vial comprising an aqueous diluent of prescribed buffer orpreservative, wherein said packaging material comprises a label thatinstructs a patient to reconstitute the at least one anti-IL-6 antibodyin the aqueous diluent to form a solution that can be held over a periodof twenty-four hours or greater.

The at least one anti-IL-6 antibody used in accordance with the presentinvention can be produced by recombinant means, including from mammaliancell or transgenic preparations, or can be purified from otherbiological sources, as described herein or as known in the art.

The range of at least one anti-IL-6 antibody in the product of thepresent invention includes amounts yielding upon reconstitution, if in awet/dry system, concentrations from about 1.0 μg/ml to about 1000 mg/ml,although lower and higher concentrations are operable and are dependenton the intended delivery vehicle, e.g., solution formulations willdiffer from transdermal patch, pulmonary, transmucosal, or osmotic ormicro pump methods.

Preferably, the aqueous diluent optionally further comprises apharmaceutically acceptable preservative. Preferred preservativesinclude those selected from the group consisting of phenol, m-cresol,p-cresol, o-cresol, chlorocresol, benzyl alcohol, alkylparaben (methyl,ethyl, propyl, butyl and the like), benzalkonium chloride, benzethoniumchloride, sodium dehydroacetate and thimerosal, or mixtures thereof. Theconcentration of preservative used in the formulation is a concentrationsufficient to yield an anti-microbial effect. Such concentrations aredependent on the preservative selected and are readily determined by theskilled artisan.

Other excipients, e.g., isotonicity agents, buffers, antioxidants, andpreservative enhancers, can be optionally and preferably added to thediluent. An isotonicity agent, such as glycerin, is commonly used atknown concentrations. A physiologically tolerated buffer is preferablyadded to provide improved pH control. The formulations can cover a widerange of pHs, such as from about pH 4 to about pH 10, and preferredranges from about pH 5 to about pH 9, and a most preferred range ofabout 6.0 to about 8.0. Preferably, the formulations of the presentinvention have a pH between about 6.8 and about 7.8. Preferred buffersinclude phosphate buffers, most preferably, sodium phosphate,particularly, phosphate buffered saline (PBS).

Other additives, such as a pharmaceutically acceptable solubilizers likeTween 20 (polyoxyethylene (20) sorbitan monolaurate), Tween 40(polyoxyethylene (20) sorbitan monopalmitate), Tween 80 (polyoxyethylene(20) sorbitan monooleate), Pluronic F68 (polyoxyethylenepolyoxypropylene block copolymers), and PEG (polyethylene glycol) ornon-ionic surfactants, such as polysorbate 20 or 80 or poloxamer 184 or188, Pluronic® polyls, other block co-polymers, and chelators, such asEDTA and EGTA, can optionally be added to the formulations orcompositions to reduce aggregation. These additives are particularlyuseful if a pump or plastic container is used to administer theformulation. The presence of pharmaceutically acceptable surfactantmitigates the propensity for the protein to aggregate.

The formulations of the present invention can be prepared by a processwhich comprises mixing at least one anti-IL-6 antibody and apreservative selected from the group consisting of phenol, m-cresol,p-cresol, o-cresol, chlorocresol, benzyl alcohol, alkylparaben, (methyl,ethyl, propyl, butyl and the like), benzalkonium chloride, benzethoniumchloride, sodium dehydroacetate and thimerosal or mixtures thereof in anaqueous diluent. Mixing the at least one anti-IL-6 antibody andpreservative in an aqueous diluent is carried out using conventionaldissolution and mixing procedures. To prepare a suitable formulation,for example, a measured amount of at least one anti-IL-6 antibody inbuffered solution is combined with the desired preservative in abuffered solution in quantities sufficient to provide the protein andpreservative at the desired concentrations. Variations of this processwould be recognized by one of ordinary skill in the art. For example,the order the components are added, whether additional additives areused, the temperature and pH at which the formulation is prepared, areall factors that can be optimized for the concentration and means ofadministration used.

The claimed formulations can be provided to patients as clear solutionsor as dual vials comprising a vial of lyophilized at least one anti-IL-6antibody that is reconstituted with a second vial containing water, apreservative and/or excipients, preferably, a phosphate buffer and/orsaline and a chosen salt, in an aqueous diluent. Either a singlesolution vial or dual vial requiring reconstitution can be reusedmultiple times and can suffice for a single or multiple cycles ofpatient treatment and thus can provide a more convenient treatmentregimen than currently available.

The present claimed articles of manufacture are useful foradministration over a period ranging from immediate to twenty-four hoursor greater. Accordingly, the presently claimed articles of manufactureoffer significant advantages to the patient. Formulations of theinvention can optionally be safely stored at temperatures of from about2° C. to about 40° C. and retain the biological activity of the proteinfor extended periods of time, thus allowing a package label indicatingthat the solution can be held and/or used over a period of 6, 12, 18,24, 36, 48, 72, or 96 hours or greater. If preserved diluent is used,such label can include use up to 1-12 months, one-half, one and a half,and/or two years.

The solutions of at least one anti-IL-6 antibody of the invention can beprepared by a process that comprises mixing at least one antibody in anaqueous diluent. Mixing is carried out using conventional dissolutionand mixing procedures. To prepare a suitable diluent, for example, ameasured amount of at least one antibody in water or buffer is combinedin quantities sufficient to provide the protein and, optionally, apreservative or buffer at the desired concentrations. Variations of thisprocess would be recognized by one of ordinary skill in the art. Forexample, the order the components are added, whether additionaladditives are used, the temperature and pH at which the formulation isprepared, are all factors that can be optimized for the concentrationand means of administration used.

The claimed products can be provided to patients as clear solutions oras dual vials comprising a vial of lyophilized at least one anti-IL-6antibody that is reconstituted with a second vial containing the aqueousdiluent. Either a single solution vial or dual vial requiringreconstitution can be reused multiple times and can suffice for a singleor multiple cycles of patient treatment and thus provides a moreconvenient treatment regimen than currently available.

The claimed products can be provided indirectly to patients by providingto pharmacies, clinics, or other such institutions and facilities, clearsolutions or dual vials comprising a vial of lyophilized at least oneanti-IL-6 antibody that is reconstituted with a second vial containingthe aqueous diluent. The clear solution in this case can be up to oneliter or even larger in size, providing a large reservoir from whichsmaller portions of the at least one antibody solution can be retrievedone or multiple times for transfer into smaller vials and provided bythe pharmacy or clinic to their customers and/or patients.

Recognized devices comprising single vial systems include pen-injectordevices for delivery of a solution, such as BD Pens, BD Autojector®,Humaject®, NovoPen®, B-D® Pen, AutoPen®, and OptiPen®, GenotropinPen®,Genotronorm Pen®, Humatro Pen®, Reco-Pen®, Roferon Pen®, Biojector®,Iject®, J-tip Needle-Free Injector®, Intraject®, Medi-Ject®, e.g., asmade or developed by Becton Dickensen (Franklin Lakes, N.J.,www.bectondickenson.com), Disetronic (Burgdorf, Switzerland,www.disetronic.com; Bioject, Portland, Oreg. (www.bioject.com); NationalMedical Products, Weston Medical (Peterborough, UK,www.weston-medical.com), Medi-Ject Corp (Minneapolis, Minn.,www.mediject.com), and similarly suitable devices. Recognized devicescomprising a dual vial system include those pen-injector systems forreconstituting a lyophilized drug in a cartridge for delivery of thereconstituted solution, such as the HumatroPen®. Examples of otherdevices suitable include pre-filled syringes, auto-injectors, needlefree injectors and needle free IV infusion sets.

The products presently claimed include packaging material. The packagingmaterial provides, in addition to the information required by theregulatory agencies, the conditions under which the product can be used.The packaging material of the present invention provides instructions tothe patient to reconstitute the at least one anti-IL-6 antibody in theaqueous diluent to form a solution and to use the solution over a periodof 2-24 hours or greater for the two vial, wet/dry, product. For thesingle vial, solution product, the label indicates that such solutioncan be used over a period of 2-24 hours or greater. The presentlyclaimed products are useful for human pharmaceutical product use.

The formulations of the present invention can be prepared by a processthat comprises mixing at least one anti-IL-6 antibody and a selectedbuffer, preferably, a phosphate buffer containing saline or a chosensalt. Mixing the at least one anti-IL-6 antibody and buffer in anaqueous diluent is carried out using conventional dissolution and mixingprocedures. To prepare a suitable formulation, for example, a measuredamount of at least one antibody in water or buffer is combined with thedesired buffering agent in water in quantities sufficient to provide theprotein and buffer at the desired concentrations. Variations of thisprocess would be recognized by one of ordinary skill in the art. Forexample, the order the components are added, whether additionaladditives are used, the temperature and pH at which the formulation isprepared, are all factors that can be optimized for the concentrationand means of administration used.

The claimed stable or preserved formulations can be provided to patientsas clear solutions or as dual vials comprising a vial of lyophilized atleast one anti-IL-6 antibody that is reconstituted with a second vialcontaining a preservative or buffer and excipients in an aqueousdiluent. Either a single solution vial or dual vial requiringreconstitution can be reused multiple times and can suffice for a singleor multiple cycles of patient treatment and thus provides a moreconvenient treatment regimen than currently available.

Other formulations or methods of stablizing the anti-IL-6 antibody mayresult in other than a clear solution of lyophilized powder comprisingthe antibody. Among non-clear solutions are formulations comprisingparticulate suspensions, said particulates being a compositioncontaining the anti-IL-6 antibody in a structure of variable dimensionand known variously as a microsphere, microparticle, nanoparticle,nanosphere, or liposome. Such relatively homogenous, essentiallyspherical, particulate formulations containing an active agent can beformed by contacting an aqueous phase containing the active agent and apolymer and a nonaqueous phase followed by evaporation of the nonaqueousphase to cause the coalescence of particles from the aqueous phase astaught in U.S. Pat. No. 4,589,330. Porous microparticles can be preparedusing a first phase containing active agent and a polymer dispersed in acontinuous solvent and removing said solvent from the suspension byfreeze-drying or dilution-extraction-precipitation as taught in U.S.Pat. No. 4,818,542. Preferred polymers for such preparations are naturalor synthetic copolymers or polymers selected from the group consistingof gelatin agar, starch, arabinogalactan, albumin, collagen,polyglycolic acid, polylactic aced, glycolide-L(−) lactidepoly(episilon-caprolactone, poly(epsilon-caprolactone-CO-lactic acid),poly(epsilon-caprolactone-CO-glycolic acid), poly(β-hydroxy butyricacid), polyethylene oxide, polyethylene, poly(alkyl-2-cyanoacrylate),poly(hydroxyethyl methacrylate), polyamides, poly(amino acids),poly(2-hydroxyethyl DL-aspartamide), poly(ester urea),poly(L-phenylalanine/ethylene glycol/1,6-diisocyanatohexane) andpoly(methyl methacrylate). Particularly preferred polymers arepolyesters, such as polyglycolic acid, polylactic aced, glycolide-L(−)lactide poly(episilon-caprolactone, poly(epsilon-caprolactone-CO-lacticacid), and poly(epsilon-caprolactone-CO-glycolic acid. Solvents usefulfor dissolving the polymer and/or the active include: water,hexafluoroisopropanol, methylenechloride, tetrahydrofuran, hexane,benzene, or hexafluoroacetone sesquihydrate. The process of dispersingthe active containing phase with a second phase may include pressureforcing said first phase through an orifice in a nozzle to affectdroplet formation.

Dry powder formulations may result from processes other thanlyophilization, such as by spray drying or solvent extraction byevaporation or by precipitation of a crystalline composition followed byone or more steps to remove aqueous or nonaqueous solvent. Preparationof a spray-dried antibody preparation is taught in U.S. Pat. No.6,019,968. The antibody-based dry powder compositions may be produced byspray drying solutions or slurries of the antibody and, optionally,excipients, in a solvent under conditions to provide a respirable drypowder. Solvents may include polar compounds, such as water and ethanol,which may be readily dried. Antibody stability may be enhanced byperforming the spray drying procedures in the absence of oxygen, such asunder a nitrogen blanket or by using nitrogen as the drying gas. Anotherrelatively dry formulation is a dispersion of a plurality of perforatedmicrostructures dispersed in a suspension medium that typicallycomprises a hydrofluoroalkane propellant as taught in WO 9916419. Thestabilized dispersions may be administered to the lung of a patientusing a metered dose inhaler. Equipment useful in the commercialmanufacture of spray dried medicaments are manufactured by Buchi Ltd. orNiro Corp.

At least one anti-IL-6 antibody in either the stable or preservedformulations or solutions described herein, can be administered to apatient in accordance with the present invention via a variety ofdelivery methods including SC or IM injection; transdermal, pulmonary,transmucosal, implant, osmotic pump, cartridge, micro pump, or othermeans appreciated by the skilled artisan, as well-known in the art.

Therapeutic Applications

The present invention also provides a method for modulating or treatingat least one IL-6 related disease, in a cell, tissue, organ, animal, orpatient, as known in the art or as described herein, using at least oneIL-6 antibody of the present invention, e.g., administering orcontacting the cell, tissue, organ, animal, or patient with atherapeutic effective amount of IL-6 antibody. The present inventionalso provides a method for modulating or treating at least one IL-6related disease, in a cell, tissue, organ, animal, or patient including,but not limited to, at least one of obesity, an immune related disease,a cardiovascular disease, an infectious disease, a malignant disease ora neurologic disease.

The present invention also provides a method for modulating or treatingat least one IL-6 related immune related disease, in a cell, tissue,organ, animal, or patient including, but not limited to, at least one ofrheumatoid arthritis, juvenile rheumatoid arthritis, systemic onsetjuvenile rheumatoid arthritis, psoriatic arthritis, ankylosingspondilitis, gastric ulcer, seronegative arthropathies, osteoarthritis,osteolysis, aseptic loosening of orthopedic implants, inflammatory boweldisease, ulcerative colitis, systemic lupus erythematosus, cutaneouslupus erythematosus, lupus nephritis, antiphospholipid syndrome,iridocyclitis/uveitis/optic neuritis, idiopathic pulmonary fibrosis,systemic vasculitis/wegener's granulomatosis, sarcoidosis,orchitis/vasectomy reversal procedures, allergic/atopic diseases,asthma, allergic rhinitis, eczema, allergic contact dermatitis, allergicconjunctivitis, hypersensitivity pneumonitis, transplants, organtransplant rejection, graft-versus-host disease, systemic inflammatoryresponse syndrome, sepsis syndrome, gram positive sepsis, gram negativesepsis, culture negative sepsis, fungal sepsis, neutropenic fever,urosepsis, meningococcemia, trauma/hemorrhage, burns, ionizing radiationexposure, acute pancreatitis, adult respiratory distress syndrome,rheumatoid arthritis, alcohol-induced hepatitis, chronic inflammatorypathologies, sarcoidosis, Crohn's pathology, sickle cell anemia,diabetes, nephrosis, atopic diseases, hypersensitivity reactions,allergic rhinitis, hay fever, perennial rhinitis, conjunctivitis,endometriosis, asthma, urticaria, systemic anaphalaxis, dermatitis,pernicious anemia, hemolytic disease, thrombocytopenia, graft rejectionof any organ or tissue, kidney transplant rejection, heart transplantrejection, liver transplant rejection, pancreas transplant rejection,lung transplant rejection, bone marrow transplant (BMT) rejection, skinallograft rejection, cartilage transplant rejection, bone graftrejection, small bowel transplant rejection, fetal thymus implantrejection, parathyroid transplant rejection, xenograft rejection of anyorgan or tissue, allograft rejection, anti-receptor hypersensitivityreactions, Graves disease, Raynaud's disease, type B insulin-resistantdiabetes, asthma, myasthenia gravis, antibody-meditated cytotoxicity,type III hypersensitivity reactions, POEMS syndrome (polyneuropathy,organomegaly, endocrinopathy, monoclonal gammopathy, and skin changessyndrome), polyneuropathy, organomegaly, endocrinopathy, monoclonalgammopathy, skin changes syndrome, antiphospholipid syndrome, pemphigus,scleroderma, mixed connective tissue disease, idiopathic Addison'sdisease, diabetes mellitus, chronic active hepatitis, primary billiarycirrhosis, vitiligo, vasculitis, post-MI cardiotomy syndrome, type IVhypersensitivity, contact dermatitis, hypersensitivity pneumonitis,allograft rejection, granulomas due to intracellular organisms, drugsensitivity, metabolic/idiopathic, Wilson's disease, hemachromatosis,alpha-1-antitrypsin deficiency, diabetic retinopathy, hashimoto'sthyroiditis, osteoporosis, hypothalamic-pituitary-adrenal axisevaluation, primary biliary cirrhosis, thyroiditis, encephalomyelitis,cachexia, cystic fibrosis, neonatal chronic lung disease, chronicobstructive pulmonary disease (COPD), familial hematophagocyticlymphohistiocytosis, dermatologic conditions, psoriasis, alopecia,nephrotic syndrome, nephritis, glomerular nephritis, acute renalfailure, hemodialysis, uremia, toxicity, preeclampsia, okt3 therapy,anti-cd3 therapy, cytokine therapy, chemotherapy, radiation therapy(e.g., including but not limited to, asthenia, anemia, cachexia, and thelike), chronic salicylate intoxication, and the like. See, e.g., theMerck Manual, 12th-17th Editions, Merck & Company, Rahway, N.J. (1972,1977, 1982, 1987, 1992, 1999), Pharmacotherapy Handbook, Wells et al.,eds., Second Edition, Appleton and Lange, Stamford, Conn. (1998, 2000),each entirely incorporated by reference.

The present invention also provides a method for modulating or treatingat least one cardiovascular disease in a cell, tissue, organ, animal, orpatient, including, but not limited to, at least one of cardiac stunsyndrome, myocardial infarction, congestive heart failure, stroke,ischemic stroke, hemorrhage, acute coronary syndrome, arteriosclerosis,atherosclerosis, restenosis, diabetic arteriosclerotic disease,hypertension, arterial hypertension, renovascular hypertension, syncope,shock, syphilis of the cardiovascular system, heart failure, corpulmonale, primary pulmonary hypertension, cardiac arrhythmias, atrialectopic beats, atrial flutter, atrial fibrillation (sustained orparoxysmal), post perfusion syndrome, cardiopulmonary bypassinflammation response, chaotic or multifocal atrial tachycardia, regularnarrow QRS tachycardia, specific arrythmias, ventricular fibrillation,His bundle arrythmias, atrioventricular block, bundle branch block,myocardial ischemic disorders, coronary artery disease, angina pectoris,myocardial infarction, cardiomyopathy, dilated congestivecardiomyopathy, restrictive cardiomyopathy, valvular heart diseases,endocarditis, pericardial disease, cardiac tumors, aordic and peripheralaneurysms, aortic dissection, inflammation of the aorta, occlusion ofthe abdominal aorta and its branches, peripheral vascular disorders,occlusive arterial disorders, peripheral atherosclerotic disease,thromboangiitis obliterans, functional peripheral arterial disorders,Raynaud's phenomenon and disease, acrocyanosis, erythromelalgia, venousdiseases, venous thrombosis, varicose veins, arteriovenous fistula,lymphederma, lipedema, unstable angina, reperfusion injury, post pumpsyndrome, ischemia-reperfusion injury, and the like. Such a method canoptionally comprise administering an effective amount of a compositionor pharmaceutical composition comprising at least one anti-IL-6 antibodyto a cell, tissue, organ, animal or patient in need of such modulation,treatment or therapy.

The present invention also provides a method for modulating or treatingat least one IL-6 related infectious disease in a cell, tissue, organ,animal or patient, including, but not limited to, at least one of: acuteor chronic bacterial infection, acute and chronic parasitic orinfectious processes, including bacterial, viral and fungal infections,HIV infection/HIV neuropathy, meningitis, hepatitis (e.g., A, B or C, orthe like), septic arthritis, peritonitis, pneumonia, epiglottitis, e.coli 0157:h7, hemolytic uremic syndrome/thrombolytic thrombocytopenicpurpura, malaria, dengue hemorrhagic fever, leishmaniasis, leprosy,toxic shock syndrome, streptococcal myositis, gas gangrene,mycobacterium tuberculosis, mycobacterium avium intracellulare,pneumocystis carinii pneumonia, pelvic inflammatory disease,orchitis/epidydimitis, legionella, lyme disease, influenza a,epstein-barr virus, viral-associated hemaphagocytic syndrome, viralencephalitis/aseptic meningitis, and the like.

The present invention also provides a method for modulating or treatingat least one IL-6 related malignant disease in a cell, tissue, organ,animal or patient, including, but not limited to, at least one of:leukemia, acute leukemia, acute lymphoblastic leukemia (ALL), acutelymphocytic leukemia, B-cell, T-cell or FAB ALL, acute myeloid leukemia(AML), acute myelogenous leukemia, chromic myelocytic leukemia (CML),chronic lymphocytic leukemia (CLL), hairy cell leukemia, myelodyplasticsyndrome (MDS), a lymphoma, Hodgkin's disease, a malignant lymphoma,non-hodgkin's lymphoma, Burkitt's lymphoma, multiple myeloma, Kaposi'ssarcoma, colorectal carcinoma, pancreatic carcinoma, nasopharyngealcarcinoma, malignant histiocytosis, paraneoplasticsyndrome/hypercalcemia of malignancy, solid tumors, bladder cancer,breast cancer, colorectal cancer, endometrial cancer, head cancer, neckcancer, hereditary nonpolyposis cancer, Hodgkin's lymphoma, livercancer, lung cancer, non-small cell lung cancer, ovarian cancer,pancreatic cancer, prostate cancer, renal cell carcinoma, testicularcancer, adenocarcinomas, sarcomas, malignant melanoma, hemangioma,metastatic disease, cancer related bone resorption, cancer related bonepain, and the like.

The present invention also provides a method for modulating or treatingat least one IL-6 related neurologic disease in a cell, tissue, organ,animal or patient, including, but not limited to, at least one of:neurodegenerative diseases, multiple sclerosis, migraine headache, AIDSdementia complex, demyelinating diseases, such as multiple sclerosis andacute transverse myelitis; extrapyramidal and cerebellar disorders, suchas lesions of the corticospinal system; disorders of the basal ganglia;hyperkinetic movement disorders, such as Huntington's Chorea and senilechorea; drug-induced movement disorders, such as those induced by drugswhich block CNS dopamine receptors; hypokinetic movement disorders, suchas Parkinson's disease; Progressive supranucleo Palsy; structurallesions of the cerebellum; spinocerebellar degenerations, such as spinalataxia, Friedreich's ataxia, cerebellar cortical degenerations, multiplesystems degenerations (Mencel, Dejerine-Thomas, Shi-Drager, andMachado-Joseph); systemic disorders (Refsum's disease,abetalipoprotemia, ataxia, telangiectasia, and mitochondrialmulti-system disorder); demyelinating core disorders, such as multiplesclerosis, acute transverse myelitis; and disorders of the motor unitsuch as neurogenic muscular atrophies (anterior horn cell degeneration,such as amyotrophic lateral sclerosis, infantile spinal muscular atrophyand juvenile spinal muscular atrophy); Alzheimer's disease; Down'sSyndrome in middle age; Diffuse Lewy body disease; Senile Dementia ofLewy body type; Wernicke-Korsakoff syndrome; chronic alcoholism;Creutzfeldt-Jakob disease; Subacute sclerosing panencephalitis,Hallerrorden-Spatz disease; Dementia pugilistica; neurotraumatic injury(e.g., spinal cord injury, brain injury, concussion, repetitiveconcussion); pain; inflammatory pain; autism; depression; stroke;cognitive disorders; epilepsy; and the like. Such a method canoptionally comprise administering an effective amount of a compositionor pharmaceutical composition comprising at least one TNF antibody orspecified portion or variant to a cell, tissue, organ, animal or patientin need of such modulation, treatment or therapy. See, e.g., the MerckManual, 16^(th) Edition, Merck & Company, Rahway, N.J. (1992).

The present invention also provides a method for modulating or treatingat least one IL-6 related wound, trauma or tissue injury or relatedchronic condition, in a cell, tissue, organ, animal or patient,including, but not limited to, at least one of: bodily injury or atrauma associated with oral surgery including periodontal surgery, toothextraction(s), endodontic treatment, insertion of tooth implants,application and use of tooth prosthesis; or wherein the wound isselected from the group consisting of aseptic wounds, contused wounds,incised wounds, lacerated wounds, non-penetrating wounds, open wounds,penetrating wounds, perforating wounds, puncture wounds, septic wounds,infarctions and subcutaneous wounds; or wherein the wound is selectedfrom the group consisting of ischemic ulcers, pressure sores, fistulae,severe bites, thermal burns and donor site wounds; or wherein the woundis an aphthous wound, a traumatic wound or a herpes associated wound.

Wounds and/or ulcers are normally found protruding from the skin or on amucosal surface or as a result of an infarction in an organ (“stroke”).A wound may be a result of a soft tissue defect or a lesion or of anunderlying condition. In the present context, the term “skin” relates tothe outermost surface of the body of an animal, including a human, andembraces intact or almost intact skin as well as an injured skinsurface. The term “mucosa” relates to undamaged or damaged mucosa of ananimal, such as a human, and may be the oral, buccal, aural, nasal,lung, eye, gastrointestinal, vaginal, or rectal mucosa.

In the present context the term “wound” denotes a bodily injury withdisruption of the normal integrity of tissue structures. The term isalso intended to encompass the terms “sore,” “lesion,” “necrosis,” and“ulcer.” Normally, the term “sore” is a popular term for almost anylesion of the skin or mucous membranes and the term “ulcer” is a localdefect, or excavation, of the surface of an organ or tissue, which isproduced by the sloughing of necrotic tissue. Lesion generally relatesto any tissue defect. Necrosis is related to dead tissue resulting frominfection, injury, inflammation or infarctions.

The term “wound” used in the present context denotes any wound (seebelow for a classification of wounds) and at any particular stage in thehealing process, including the stage before any healing has initiated oreven before a specific wound like a surgical incision is made(prophylactic treatment). Examples of wounds which can be preventedand/or treated in accordance with the present invention are, e.g.,aseptic wounds, contused wounds, incised wounds, lacerated wounds,non-penetrating wounds (i.e., wounds in which there is no disruption ofthe skin but there is injury to underlying structures), open wounds,penetrating wounds, perforating wounds, puncture wounds, septic wounds,subcutaneous wounds, etc. Examples of sores are bed sores, canker sores,chrome sores, cold sores, pressure sores, etc. Examples of ulcers are,e.g., a peptic ulcer, duodenal ulcer, gastric ulcer, gouty ulcer,diabetic ulcer, hypertensive ischemic ulcer, stasis ulcer, ulcus cruris(venous ulcer), sublingual ulcer, submucous ulcer, symptomatic ulcer,trophic ulcer, tropical ulcer, and veneral ulcer, e.g., caused bygonorrhoea (including urethritis, endocervicitis and proctitis).Conditions related to wounds or sores which may be successfully treatedaccording to the invention are burns, anthrax, tetanus, gas gangrene,scarlatina, erysipelas, sycosis barbae, folliculitis, impetigocontagiosa, or impetigo bullosa, etc. There is often a certain overlapbetween the use of the terms “wound” and “ulcer” and “wound” and “sore”and, furthermore, the terms are often used at random. Therefore, asmentioned above, in the present context the term “wound” encompasses theterms “ulcer,” “lesion,” “sore” and “infarction,” and the terms areindiscriminately used unless otherwise indicated.

The kinds of wounds to be treated according to the invention includealso (i) general wounds, such as, e.g., surgical, traumatic, infectious,ischemic, thermal, chemical and bullous wounds; (ii) wounds specific forthe oral cavity, such as, e.g., post-extraction wounds, endodonticwounds especially in connection with treatment of cysts and abscesses,ulcers and lesions of bacterial, viral or autoimmunological origin,mechanical, chemical, thermal, infectious and lichenoid wounds; herpesulcers, stomatitis aphthosa, acute necrotising ulcerative gingivitis andburning mouth syndrome are specific examples; and (iii) wounds on theskin, such as, e.g., neoplasm, burns (e.g. chemical, thermal), lesions(bacterial, viral, autoimmunological), bites and surgical incisions.Another way of classifying wounds is as (i) small tissue loss due tosurgical incisions, minor abrasions and minor bites, or as (ii)significant tissue loss. The latter group includes ischemic ulcers,pressure sores, fistulae, lacerations, severe bites, thermal burns anddonor site wounds (in soft and hard tissues) and infarctions.

Other wounds that are of importance in connection with the presentinvention are wounds like ischemic ulcers, pressure sores, fistulae,severe bites, thermal burns and donor site wounds. Ischemic ulcers andpressure sores are wounds which normally only heal very slowly andespecially in such cases, an improved and more rapid healing process isof course of great importance for the patient. Furthermore, the costsinvolved in the treatment of patients suffering from such wounds aremarkedly reduced when the healing is improved and takes place morerapidly.

Donor site wounds are wounds which, e.g., occur in connection withremoval of hard tissue from one part of the body to another part of thebody, e.g., in connection with transplantation. The wounds resultingfrom such operations are very painful and an improved healing istherefore most valuable. The term “skin” is used in a very broad senseembracing the epidermal layer of the skin and—in those cases where theskin surface is more or less injured—also the dermal layer of the skin.Apart from the stratum corneum, the epidermal layer of the skin is theouter (epithelial) layer and the deeper connective tissue layer of theskin is called the dermis.

The present invention also provides a method for modulating or treatingosteoarthritis, systemic lupus erythmatosus, cutaneous lupuserythematosus, lupus nephritis, type II diabetes mellitus, and chronicobstructive pulmonary disorder, among the other diseases listed above asIL-6 related, in a cell, tissue, organ, animal, or patient including,but not limited to, at least one of immune related disease,cardiovascular disease, infectious, malignant and/or neurologic disease.Such a method can optionally comprise administering an effective amountof at least one composition or pharmaceutical composition comprising atleast one anti-IL-6 antibody to a cell, tissue, organ, animal or patientin need of such modulation, treatment or therapy.

Any method of the present invention can comprise administering aneffective amount of a composition or pharmaceutical compositioncomprising at least one anti-IL-6 antibody to a cell, tissue, organ,animal or patient in need of such modulation, treatment or therapy. Sucha method can optionally further comprise co-administration orcombination therapy for treating such diseases or disorders, wherein theadministering of said at least one anti-IL-6 antibody, specified portionor variant thereof, further comprises administering, beforeconcurrently, and/or after, at least one selected from at least one TNFantagonist (e.g., but not limited to, a TNF chemical or proteinantagonist, TNF monoclonal or polyclonal antibody or fragment, a solubleTNF receptor (e.g., p55, p70 or p85) or fragment, fusion polypeptidesthereof, or a small molecule TNF antagonist, e.g., TNF binding protein Ior II (TBP-1 or TBP-II), nerelimonmab, infliximab, etanercept (Enbrel™)adalimulab (Humira™), CDP-571, CDP-870, afelimomab, lenercept, and thelike), an antirheumatic (e.g., methotrexate, auranofin, aurothioglucose,azathioprine, gold sodium thiomalate, hydroxychloroquine sulfate,leflunomide, sulfasalzine), a muscle relaxant, a narcotic, a non-steroidanti-inflammatory drug (NSAID), an analgesic, an anesthetic, a sedative,a local anesthetic, a neuromuscular blocker, an antimicrobial (e.g.,aminoglycoside, an antifungal, an antiparasitic, an antiviral, acarbapenem, cephalosporin, a flurorquinolone, a macrolide, a penicillin,a sulfonamide, a tetracycline, another antimicrobial), an antipsoriatic,a corticosteriod, an anabolic steroid, a diabetes related agent, amineral, a nutritional, a thyroid agent, a vitamin, a calcium relatedhormone, an antidiarrheal, an antitussive, an antiemetic, an antiulcer,a laxative, an anticoagulant, an erythropoietin (e.g., epoetin alpha), afilgrastim (e.g., G-CSF, Neupogen), a sargramostim (GM-CSF, Leukine), animmunization, an immunoglobulin, an immunosuppressive (e.g.,basiliximab, cyclosporine, daclizumab), a growth hormone, a hormonereplacement drug, an estrogen receptor modulator, a mydriatic, acycloplegic, an alkylating agent, an antimetabolite, a mitoticinhibitor, a radiopharmaceutical, an antidepressant, antimanic agent, anantipsychotic, an anxiolytic, a hypnotic, a sympathomimetic, astimulant, donepezil, tacrine, an asthma medication, a beta agonist, aninhaled steroid, a leukotriene inhibitor, a methylxanthine, a cromolyn,an epinephrine or analog, dornase alpha (Pulmozyme), a cytokine or acytokine antagonist. Suitable dosages are well known in the art. See,e.g., Wells et al., eds., Pharmacotherapy Handbook, 2^(nd) Edition,Appleton and Lange, Stamford, Conn. (2000); PDR Pharmacopoeia, TarasconPocket Pharmacopoeia 2000, Deluxe Edition, Tarascon Publishing, LomaLinda, Calif. (2000); Nursing 2001 Handbook of Drugs, 21^(st) edition,Springhouse Corp., Springhouse, Pa., 2001; Health Professional's DrugGuide 2001, ed., Shannon, Wilson, Stang, Prentice-Hall, Inc, UpperSaddle River, N.J. each of which references are entirely incorporatedherein by reference.

TNF antagonists suitable for compositions, combination therapy,co-administration, devices and/or methods of the present invention(further comprising at least one antibody, specified portion and variantthereof, of the present invention), include, but are not limited to,anti-TNF antibodies (e.g., at least one TNF antagonist as definedabove), antigen-binding fragments thereof, and receptor molecules whichbind specifically to TNF; compounds which prevent and/or inhibit TNFsynthesis, TNF release or its action on target cells, such asthalidomide, tenidap, phosphodiesterase inhibitors (e.g, pentoxifyllineand rolipram), A2b adenosine receptor agonists and A2b adenosinereceptor enhancers; compounds which prevent and/or inhibit TNF receptorsignalling, such as mitogen activated protein (MAP) kinase inhibitors;compounds which block and/or inhibit membrane TNF cleavage, such asmetalloproteinase inhibitors; compounds which block and/or inhibit TNFactivity, such as angiotensin converting enzyme (ACE) inhibitors (e.g.,captopril); and compounds which block and/or inhibit TNF productionand/or synthesis, such as MAP kinase inhibitors.

As used herein, a “tumor necrosis factor antibody,” “TNF antibody,”“TNFα antibody,” or fragment and the like decreases, blocks, inhibits,abrogates or interferes with TNFα activity in vitro, in situ and/or,preferably, in vivo. For example, a suitable TNF human antibody of thepresent invention can bind TNFα and includes anti-TNF antibodies,antigen-binding fragments thereof, and specified mutants or domainsthereof that bind specifically to TNFα. A suitable TNF antibody orfragment can also decrease block, abrogate, interfere, prevent and/orinhibit TNF RNA, DNA or protein synthesis, TNF release, TNF receptorsignaling, membrane TNF cleavage, TNF activity, TNF production and/orsynthesis.

An example of a TNF antibody or antagonist is the chimeric antibody cA2.Additional examples of monoclonal anti-TNF antibodies that can be usedin the present invention are described in the art (see, e.g., U.S. Pat.No. 5,231,024; Moller, A. et al., Cytokine 2(3):162-169 (1990); U.S.application Ser. No. 07/943,852 (filed Sep. 11, 1992); Rathjen et al.,International Publication No. WO 91/02078 (published Feb. 21, 1991);Rubin et al., EPO Patent Publication No. 0 218 868 (published Apr. 22,1987); Yone et al., EPO Patent Publication No. 0 288 088 (Oct. 26,1988); Liang, et al., Biochem. Biophys. Res. Comm. 137:847-854 (1986);Meager, et al., Hybridoma 6:305-311 (1987); Fendly et al., Hybridoma6:359-369 (1987); Bringman, et al., Hybridoma 6:489-507 (1987); andHirai, et al., J. Immunol. Meth. 96:57-62 (1987).

TNF Receptor Molecules

Preferred TNF receptor molecules useful in the present invention arethose that bind TNFα with high affinity (see, e.g., Feldmann et al.,International Publication No. WO 92/07076 (published Apr. 30, 1992);Schall et al., Cell 61:361-370 (1990); and Loetscher et al., Cell61:351-359 (1990), which references are entirely incorporated herein byreference) and optionally possess low immunogenicity. In particular, the55 kDa (p55 TNF-R) and the 75 kDa (p75 TNF-R) TNF cell surface receptorsare useful in the present invention. Truncated forms of these receptors,comprising the extracellular domains (ECD) of the receptors orfunctional portions thereof (see, e.g., Corcoran et al., Eur. J.Biochem. 223:831-840 (1994)), are also useful in the present invention.Truncated forms of the TNF receptors, comprising the ECD, have beendetected in urine and serum as 30 kDa and 40 kDa TNFα inhibitory bindingproteins (Engelmann, H. et al., J. Biol. Chem. 265:1531-1536 (1990)).TNF receptor multimeric molecules and TNF immunoreceptor fusionmolecules, and derivatives and fragments or portions thereof, areadditional examples of TNF receptor molecules which are useful in themethods and compositions of the present invention.

TNF receptor multimeric molecules useful in the present inventioncomprise all or a functional portion of the ECD of two or more TNFreceptors linked via one or more polypeptide linkers or other nonpeptidelinkers, such as polyethylene glycol (PEG). An example of such a TNFimmunoreceptor fusion molecule is TNF receptor/IgG fusion protein. TNFimmunoreceptor fusion molecules and methods for their production havebeen described in the art (Lesslauer et al., Eur. J. Immunol.21:2883-2886 (1991); Ashkenazi et al., Proc. Natl. Acad. Sci. USA88:10535-10539 (1991); Peppel et al., J. Exp. Med. 174:1483-1489 (1991);Kolls et al., Proc. Natl. Acad. Sci. USA 91:215-219 (1994); Butler etal., Cytokine 6(6):616-623 (1994); Baker et al., Eur. J. Immunol.24:2040-2048 (1994); Beutler et al., U.S. Pat. No. 5,447,851; and U.S.application Ser. No. 08/442,133 (filed May 16, 1995), each of whichreferences are entirely incorporated herein by reference). Methods forproducing immunoreceptor fusion molecules can also be found in Capon etal., U.S. Pat. No. 5,116,964; Capon et al., U.S. Pat. No. 5,225,538; andCapon et al., Nature 337:525-531 (1989), which references are entirelyincorporated herein by reference.

Cytokines include any known cytokine. See, e.g., CopewithCytokines.com.Cytokine antagonists include, but are not limited to, any antibody,fragment or mimetic, any soluble receptor, fragment or mimetic, anysmall molecule antagonist, or any combination thereof.

Therapeutic Treatments

Any method of the present invention can comprise a method for treatingan IL-6 mediated disorder, comprising administering an effective amountof a composition or pharmaceutical composition comprising at least oneanti-IL-6 antibody to a cell, tissue, organ, animal or patient in needof such modulation, treatment or therapy. Such a method can optionallyfurther comprise co-administration or combination therapy for treatingsuch diseases or disorders, wherein the administering of said at leastone anti-IL-6 antibody, specified portion or variant thereof, furthercomprises administering before, concurrently, and/or after, at least oneselected from an anti-infective drug, a cardiovascular (CV) system drug,a central nervous system (CNS) drug, an autonomic nervous system (ANS)drug, a respiratory tract drug, a gastrointestinal (GI) tract drug, ahormonal drug, a drug for fluid or electrolyte balance, a hematologicdrug, an antineoplastic, an immunomodulation drug, an ophthalmic, oticor nasal drug, a topical drug, a nutritional drug or the like, at leastone TNF antagonist (e.g., but not limited to a TNF antibody or fragment,a soluble TNF receptor or fragment, fusion proteins thereof, or a smallmolecule TNF antagonist), an antirheumatic (e.g., methotrexate,auranofin, aurothioglucose, azathioprine, etanercept, gold sodiumthiomalate, hydroxychloroquine sulfate, leflunomide, sulfasalzine), amuscle relaxant, a narcotic, a non-steroid anti-inflammatory drug(NSAID), an analgesic, an anesthetic, a sedative, a local anesthetic, aneuromuscular blocker, an antimicrobial (e.g., aminoglycoside, anantifungal, an antiparasitic, an antiviral, a carbapenem, cephalosporin,a flurorquinolone, a macrolide, a penicillin, a sulfonamide, atetracycline, another antimicrobial), an antipsoriatic, acorticosteriod, an anabolic steroid, a diabetes related agent, amineral, a nutritional, a thyroid agent, a vitamin, a calcium relatedhormone, an antidiarrheal, an antitussive, an antiemetic, an antiulcer,a laxative, an anticoagulant, an erythropoietin (e.g., epoetin alpha), afilgrastim (e.g., G-CSF, Neupogen), a sargramostim (GM-CSF, Leukine), animmunization, an immunoglobulin, an immunosuppressive (e.g.,basiliximab, cyclosporine, daclizumab), a growth hormone, a hormonereplacement drug, an estrogen receptor modulator, a mydriatic, acycloplegic, an alkylating agent, an antimetabolite, a mitoticinhibitor, a radiopharmaceutical, an antidepressant, antimanic agent, anantipsychotic, an anxiolytic, a hypnotic, a sympathomimetic, astimulant, donepezil, tacrine, an asthma medication, a beta agonist, aninhaled steroid, a leukotriene inhibitor, a methylxanthine, a cromolyn,an epinephrine or analog, dornase alpha (Pulmozyme), a cytokine or acytokine antagonist. Such drugs are well known in the art, includingformulations, indications, dosing and administration for each presentedherein (see., e.g., Nursing 2001 Handbook of Drugs, 21^(st) edition,Springhouse Corp., Springhouse, Pa., 2001; Health Professional's DrugGuide 2001, ed., Shannon, Wilson, Stang, Prentice-Hall, Inc, UpperSaddle River, N.J.; Pharmcotherapy Handbook, Wells et al., ed., Appleton& Lange, Stamford, Conn., each entirely incorporated herein byreference).

Typically, treatment of pathologic conditions is effected byadministering an effective amount or dosage of at least one anti-IL-6antibody composition that total, on average, a range from at least about0.01 to 500 milligrams of at least one anti-IL-6 antibody per kilogramof patient per dose, and, preferably, from at least about 0.1 to 100milligrams antibody/kilogram of patient per single or multipleadministration, depending upon the specific activity of the active agentcontained in the composition. Alternatively, the effective serumconcentration can comprise 0.1-5000 μg/ml serum concentration per singleor multiple administration. Suitable dosages are known to medicalpractitioners and will, of course, depend upon the particular diseasestate, specific activity of the composition being administered, and theparticular patient undergoing treatment. In some instances, to achievethe desired therapeutic amount, it can be necessary to provide forrepeated administration, i.e., repeated individual administrations of aparticular monitored or metered dose, where the individualadministrations are repeated until the desired daily dose or effect isachieved.

Preferred doses can optionally include about 0.1-99 and/or 100-500mg/kg/administration, or any range, value or fraction thereof, or toachieve a serum concentration of about 0.1-5000 μg/ml serumconcentration per single or multiple administration, or any range, valueor fraction thereof. A preferred dosage range for the anti-IL-6 antibodyof the present invention is from about 1 mg/kg, up to about 3, about 6or about 12 mg/kg of body weight of the patient.

Alternatively, the dosage administered can vary depending upon knownfactors, such as the pharmacodynamic characteristics of the particularagent, and its mode and route of administration; age, health, and weightof the recipient; nature and extent of symptoms, kind of concurrenttreatment, frequency of treatment, and the effect desired. Usually adosage of active ingredient can be about 0.1 to 100 milligrams perkilogram of body weight. Ordinarily 0.1 to 50, and, preferably, 0.1 to10 milligrams per kilogram per administration or in sustained releaseform is effective to obtain desired results.

As a non-limiting example, treatment of humans or animals can beprovided as a one-time or periodic dosage of at least one antibody ofthe present invention about 0.1 to 100 mg/kg or any range, value orfraction thereof per day, on at least one of day 1-40, or, alternativelyor additionally, at least one of week 1 52, or, alternatively oradditionally, at least one of 1-20 years, or any combination thereof,using single, infusion or repeated doses.

Dosage forms (composition) suitable for internal administrationgenerally contain from about 0.001 milligram to about 500 milligrams ofactive ingredient per unit or container. In these pharmaceuticalcompositions the active ingredient will ordinarily be present in anamount of about 0.5-99.999% by weight based on the total weight of thecomposition.

For parenteral administration, the antibody can be formulated as asolution, suspension, emulsion, particle, powder, or lyophilized powderin association, or separately provided, with a pharmaceuticallyacceptable parenteral vehicle. Examples of such vehicles are water,saline, Ringer's solution, dextrose solution, and about 1-10% humanserum albumin. Liposomes and nonaqueous vehicles, such as fixed oils,can also be used. The vehicle or lyophilized powder can containadditives that maintain isotonicity (e.g., sodium chloride, mannitol)and chemical stability (e.g., buffers and preservatives). Theformulation is sterilized by known or suitable techniques.

Suitable pharmaceutical carriers are described in the most recentedition of Remington's Pharmaceutical Sciences, A. Osol, a standardreference text in this field.

Alternative Administration

Many known and developed modes can be used according to the presentinvention for administering pharmaceutically effective amounts of atleast one anti-IL-6 antibody according to the present invention. Whilepulmonary administration is used in the following description, othermodes of administration can be used according to the present inventionwith suitable results. IL-6 antibodies of the present invention can bedelivered in a carrier, as a solution, emulsion, colloid, or suspension,or as a dry powder, using any of a variety of devices and methodssuitable for administration by inhalation or other modes described herewithin or known in the art.

Parenteral Formulations and Administration

Formulations for parenteral administration can contain as commonexcipients sterile water or saline, polyalkylene glycols, such aspolyethylene glycol, oils of vegetable origin, hydrogenated naphthalenesand the like. Aqueous or oily suspensions for injection can be preparedby using an appropriate emulsifier or humidifier and a suspending agent,according to known methods. Agents for injection can be a non-toxic,non-orally administrable diluting agent, such as aqueous solution, asterile injectable solution or suspension in a solvent. As the usablevehicle or solvent, water, Ringer's solution, isotonic saline, etc. areallowed; as an ordinary solvent or suspending solvent, sterileinvolatile oil can be used. For these purposes, any kind of involatileoil and fatty acid can be used, including natural or synthetic orsemisynthetic fatty oils or fatty acids; natural or synthetic orsemisynthetic mono- or di- or tri-glycerides. Parental administration isknown in the art and includes, but is not limited to, conventional meansof injections, a gas pressured needle-less injection device as describedin U.S. Pat. No. 5,851,198, and a laser perforator device as describedin U.S. Pat. No. 5,839,446 entirely incorporated herein by reference.

Alternative Delivery

The invention further relates to the administration of at least oneanti-IL-6 antibody by parenteral, subcutaneous, intramuscular,intravenous, intrarticular, intrabronchial, intraabdominal,intracapsular, intracartilaginous, intracavitary, intracelial,intracerebellar, intracerebroventricular, intracolic, intracervical,intragastric, intrahepatic, intramyocardial, intraosteal, intrapelvic,intrapericardiac, intraperitoneal, intrapleural, intraprostatic,intrapulmonary, intrarectal, intrarenal, intraretinal, intraspinal,intrasynovial, intrathoracic, intrauterine, intravesical, intralesional,bolus, vaginal, rectal, buccal, sublingual, intranasal, or transdermalmeans. At least one anti-IL-6 antibody composition can be prepared foruse for parenteral (subcutaneous, intramuscular or intravenous) or anyother administration particularly in the form of liquid solutions orsuspensions; for use in vaginal or rectal administration particularly insemisolid forms, such as, but not limited to, creams and suppositories;for buccal, or sublingual administration, such as, but not limited to,in the form of tablets or capsules; or intranasally, such as, but notlimited to, the form of powders, nasal drops or aerosols or certainagents; or transdermally, such as not limited to a gel, ointment,lotion, suspension or patch delivery system with chemical enhancers suchas dimethyl sulfoxide to either modify the skin structure or to increasethe drug concentration in the transdermal patch (Junginger, et al. In“Drug Permeation Enhancement;” Hsieh, D. S., Eds., pp. 59-90 (MarcelDekker, Inc. New York 1994, entirely incorporated herein by reference),or with oxidizing agents that enable the application of formulationscontaining proteins and peptides onto the skin (WO 98/53847), orapplications of electric fields to create transient transport pathways,such as electroporation, or to increase the mobility of charged drugsthrough the skin, such as iontophoresis, or application of ultrasound,such as sonophoresis (U.S. Pat. Nos. 4,309,989 and 4,767,402) (the abovepublications and patents being entirely incorporated herein byreference).

Pulmonary/Nasal Administration

For pulmonary administration, preferably, at least one anti-IL-6antibody composition is delivered in a particle size effective forreaching the lower airways of the lung or sinuses. According to theinvention, at least one anti-IL-6 antibody can be delivered by any of avariety of inhalation or nasal devices known in the art foradministration of a therapeutic agent by inhalation. These devicescapable of depositing aerosolized formulations in the sinus cavity oralveoli of a patient include metered dose inhalers, nebulizers, drypowder generators, sprayers, and the like. Other devices suitable fordirecting the pulmonary or nasal administration of antibodies are alsoknown in the art. All such devices can use formulations suitable for theadministration for the dispensing of antibody in an aerosol. Suchaerosols can be comprised of either solutions (both aqueous and nonaqueous) or solid particles.

Metered dose inhalers like the Ventolin® metered dose inhaler, typicallyuse a propellent gas and require actuation during inspiration (See,e.g., WO 94/16970, WO 98/35888). Dry powder inhalers like Turbuhaler™(Astra), Rotahaler® (Glaxo), Diskus® (Glaxo), Spiros™ inhaler (Dura),devices marketed by Inhale Therapeutics, and the Spinhaler® powderinhaler (Fisons), use breath-actuation of a mixed powder (U.S. Pat. No.4,668,218 Astra, EP 237507 Astra, WO 97/25086 Glaxo, WO 94/08552 Dura,U.S. Pat. No. 5,458,135 Inhale, WO 94/06498 Fisons, entirelyincorporated herein by reference). Nebulizers like AERx™ Aradigm, theUltravent® nebulizer (Mallinckrodt), and the Acorn II® nebulizer(Marquest Medical Products) (U.S. Pat. No. 5,404,871 Aradigm, WO97/22376), the above references entirely incorporated herein byreference, produce aerosols from solutions, while metered dose inhalers,dry powder inhalers, etc. generate small particle aerosols. Thesespecific examples of commercially available inhalation devices areintended to be a representative of specific devices suitable for thepractice of this invention, and are not intended as limiting the scopeof the invention.

Preferably, a composition comprising at least one anti-IL-6 antibody isdelivered by a dry powder inhaler or a sprayer. There are severaldesirable features of an inhalation device for administering at leastone antibody of the present invention. For example, delivery by theinhalation device is advantageously reliable, reproducible, andaccurate. The inhalation device can optionally deliver small dryparticles, e.g., less than about 10 μm, preferably about 1-5 μm, forgood respirability.

Administration of IL-6 Antibody Compositions as a Spray

A spray including IL-6 antibody composition can be produced by forcing asuspension or solution of at least one anti-IL-6 antibody through anozzle under pressure. The nozzle size and configuration, the appliedpressure, and the liquid feed rate can be chosen to achieve the desiredoutput and particle size. An electrospray can be produced, for example,by an electric field in connection with a capillary or nozzle feed.Advantageously, particles of at least one anti-IL-6 antibody compositiondelivered by a sprayer have a particle size less than about 10 μm,preferably, in the range of about 1 μm to about 5 μm, and, mostpreferably, about 2 μm to about 3 μm.

Formulations of at least one anti-IL-6 antibody composition suitable foruse with a sprayer typically include antibody composition in an aqueoussolution at a concentration of about 0.1 mg to about 100 mg of at leastone anti-IL-6 antibody composition per ml of solution or mg/gm, or anyrange, value, or fraction therein. The formulation can include agents,such as an excipient, a buffer, an isotonicity agent, a preservative, asurfactant, and, preferably, zinc. The formulation can also include anexcipient or agent for stabilization of the antibody composition, suchas a buffer, a reducing agent, a bulk protein, or a carbohydrate. Bulkproteins useful in formulating antibody compositions include albumin,protamine, or the like. Typical carbohydrates useful in formulatingantibody compositions include sucrose, mannitol, lactose, trehalose,glucose, or the like. The antibody composition formulation can alsoinclude a surfactant, which can reduce or prevent surface-inducedaggregation of the antibody composition caused by atomization of thesolution in forming an aerosol. Various conventional surfactants can beemployed, such as polyoxyethylene fatty acid esters and alcohols, andpolyoxyethylene sorbitol fatty acid esters. Amounts will generally rangebetween 0.001 and 14% by weight of the formulation. Especially preferredsurfactants for purposes of this invention are polyoxyethylene sorbitanmonooleate, polysorbate 80, polysorbate 20, or the like. Additionalagents known in the art for formulation of a protein, such as IL-6antibodies, or specified portions or variants, can also be included inthe formulation.

Administration of IL-6 Antibody Compositions by a Nebulizer

Antibody compositions of the invention can be administered by anebulizer, such as jet nebulizer or an ultrasonic nebulizer. Typically,in a jet nebulizer, a compressed air source is used to create ahigh-velocity air jet through an orifice. As the gas expands beyond thenozzle, a low-pressure region is created, which draws a solution ofantibody composition through a capillary tube connected to a liquidreservoir. The liquid stream from the capillary tube is sheared intounstable filaments and droplets as it exits the tube, creating theaerosol. A range of configurations, flow rates, and baffle types can beemployed to achieve the desired performance characteristics from a givenjet nebulizer. In an ultrasonic nebulizer, high-frequency electricalenergy is used to create vibrational, mechanical energy, typicallyemploying a piezoelectric transducer. This energy is transmitted to theformulation of antibody composition either directly or through acoupling fluid, creating an aerosol including the antibody composition.Advantageously, particles of antibody composition delivered by anebulizer have a particle size less than about 10 μm, preferably, in therange of about 1 μm to about 5 μm, and, most preferably, about 2 μm toabout 3 μm.

Formulations of at least one anti-IL-6 antibody suitable for use with anebulizer, either jet or ultrasonic, typically include a concentrationof about 0.1 mg to about 100 mg of at least one anti-IL-6 antibodyprotein per ml of solution. The formulation can include agents, such asan excipient, a buffer, an isotonicity agent, a preservative, asurfactant, and, preferably, zinc. The formulation can also include anexcipient or agent for stabilization of the at least one anti-IL-6antibody composition, such as a buffer, a reducing agent, a bulkprotein, or a carbohydrate. Bulk proteins useful in formulating at leastone anti-IL-6 antibody compositions include albumin, protamine, or thelike. Typical carbohydrates useful in formulating at least one anti-IL-6antibody include sucrose, mannitol, lactose, trehalose, glucose, or thelike. The at least one anti-IL-6 antibody formulation can also include asurfactant, which can reduce or prevent surface-induced aggregation ofthe at least one anti-IL-6 antibody caused by atomization of thesolution in forming an aerosol. Various conventional surfactants can beemployed, such as polyoxyethylene fatty acid esters and alcohols, andpolyoxyethylene sorbital fatty acid esters. Amounts will generally rangebetween about 0.001 and 4% by weight of the formulation. Especiallypreferred surfactants for purposes of this invention are polyoxyethylenesorbitan mono-oleate, polysorbate 80, polysorbate 20, or the like.Additional agents known in the art for formulation of a protein, such asantibody protein, can also be included in the formulation.

Administration of IL-6 Antibody Compositions by a Metered Dose Inhaler

In a metered dose inhaler (MDI), a propellant, at least one anti-IL-6antibody, and any excipients or other additives are contained in acanister as a mixture including a liquefied compressed gas. Actuation ofthe metering valve releases the mixture as an aerosol, preferablycontaining particles in the size range of less than about 10 μm,preferably, about 1 μm to about 5 μm, and, most preferably, about 2 μmto about 3 μm. The desired aerosol particle size can be obtained byemploying a formulation of antibody composition produced by variousmethods known to those of skill in the art, including jet-milling, spraydrying, critical point condensation, or the like. Preferred metered doseinhalers include those manufactured by 3M or Glaxo and employing ahydrofluorocarbon propellant. Formulations of at least one anti-IL-6antibody for use with a metered-dose inhaler device will generallyinclude a finely divided powder containing at least one anti-IL-6antibody as a suspension in a non-aqueous medium, for example, suspendedin a propellant with the aid of a surfactant. The propellant can be anyconventional material employed for this purpose, such aschlorofluorocarbon, a hydrochlorofluorocarbon, a hydrofluorocarbon, or ahydrocarbon, including trichlorofluoromethane, dichlorodifluoromethane,dichlorotetrafluoroethanol and 1,1,1,2-tetrafluoroethane, HFA-134a(hydrofluroalkane-134a), HFA-227 (hydrofluroalkane-227), or the like.Preferably, the propellant is a hydrofluorocarbon. The surfactant can bechosen to stabilize the at least one anti-IL-6 antibody as a suspensionin the propellant, to protect the active agent against chemicaldegradation, and the like. Suitable surfactants include sorbitantrioleate, soya lecithin, oleic acid, or the like. In some cases,solution aerosols are preferred using solvents, such as ethanol.Additional agents known in the art for formulation of a protein can alsobe included in the formulation. One of ordinary skill in the art willrecognize that the methods of the current invention can be achieved bypulmonary administration of at least one anti-IL-6 antibody compositionvia devices not described herein.

Oral Formulations and Administration

Formulations for oral administration rely on the co-administration ofadjuvants (e.g., resorcinols and nonionic surfactants, such aspolyoxyethylene oleyl ether and n-hexadecylpolyethylene ether) toincrease artificially the permeability of the intestinal walls, as wellas the co-administration of enzymatic inhibitors (e.g., pancreatictrypsin inhibitors, diisopropylfluorophosphate (DFF) and trasylol) toinhibit enzymatic degradation. Formulations for delivery of hydrophilicagents including proteins and antibodies and a combination of at leasttwo surfactants intended for oral, buccal, mucosal, nasal, pulmonary,vaginal transmembrane, or rectal administration are taught in U.S. Pat.No. 6,309,663. The active constituent compound of the solid-type dosageform for oral administration can be mixed with at least one additive,including sucrose, lactose, cellulose, mannitol, trehalose, raffinose,maltitol, dextran, starches, agar, arginates, chitins, chitosans,pectins, gum tragacanth, gum arabic, gelatin, collagen, casein, albumin,synthetic or semisynthetic polymer, and glyceride. These dosage formscan also contain other type(s) of additives, e.g., inactive dilutingagent, lubricant, such as magnesium stearate, paraben, preserving agent,such as sorbic acid, ascorbic acid, .alpha.-tocopherol, antioxidant suchas cysteine, disintegrator, binder, thickener, buffering agent,sweetening agent, flavoring agent, perfuming agent, etc.

Tablets and pills can be further processed into enteric-coatedpreparations. The liquid preparations for oral administration includeemulsion, syrup, elixir, suspension and solution preparations allowablefor medical use. These preparations can contain inactive diluting agentsordinarily used in said field, e.g., water. Liposomes have also beendescribed as drug delivery systems for insulin and heparin (U.S. Pat.No. 4,239,754). More recently, microspheres of artificial polymers ofmixed amino acids (proteinoids) have been used to deliverpharmaceuticals (U.S. Pat. No. 4,925,673). Furthermore, carriercompounds described in U.S. Pat. No. 5,879,681 and U.S. Pat. No.5,5,871,753 and used to deliver biologically active agents orally areknown in the art.

Mucosal Formulations and Administration

A formulation for orally administering a bioactive agent encapsulated inone or more biocompatible polymer or copolymer excipients, preferably, abiodegradable polymer or copolymer, affording microcapsules which due tothe proper size of the resultant microcapsules results in the agentreaching and being taken up by the folliculi lymphatic aggregati,otherwise known as the “Peyer's patch,” or “GALT” of the animal withoutloss of effectiveness due to the agent having passed through thegastrointestinal tract. Similar folliculi lymphatic aggregati can befound in the bronchei tubes (BALT) and the large intestine. Theabove-described tissues are referred to in general as mucosallyassociated lymphoreticular tissues (MALT). For absorption throughmucosal surfaces, compositions and methods of administering at least oneanti-IL-6 antibody include an emulsion comprising a plurality ofsubmicron particles, a mucoadhesive macromolecule, a bioactive peptide,and an aqueous continuous phase, which promotes absorption throughmucosal surfaces by achieving mucoadhesion of the emulsion particles(U.S. Pat. No. 5,514,670). Mucous surfaces suitable for application ofthe emulsions of the present invention can include corneal,conjunctival, buccal, sublingual, nasal, vaginal, pulmonary, stomachic,intestinal, and rectal routes of administration. Formulations forvaginal or rectal administration, e.g., suppositories, can contain asexcipients, for example, polyalkyleneglycols, vaseline, cocoa butter,and the like. Formulations for intranasal administration can be solidand contain as excipients, for example, lactose or can be aqueous oroily solutions of nasal drops. For buccal administration, excipientsinclude sugars, calcium stearate, magnesium stearate, pregelinatinedstarch, and the like (U.S. Pat. No. 5,849,695).

Transdermal Formulations and Administration

For transdermal administration, the at least one anti-IL-6 antibody isencapsulated in a delivery device, such as a liposome or polymericnanoparticles, microparticle, microcapsule, or microspheres (referred tocollectively as microparticles unless otherwise stated). A number ofsuitable devices are known, including microparticles made of syntheticpolymers, such as polyhydroxy acids, such as polylactic acid,polyglycolic acid and copolymers thereof, polyorthoesters,polyanhydrides, and polyphosphazenes, and natural polymers, such ascollagen, polyamino acids, albumin and other proteins, alginate andother polysaccharides, and combinations thereof (U.S. Pat. No.5,814,599).

Prolonged Administration and Formulations

It can be desirable to deliver the compounds of the present invention tothe subject over prolonged periods of time, for example, for periods ofone week to one year from a single administration. Various slow release,depot or implant dosage forms can be utilized. For example, a dosageform can contain a pharmaceutically acceptable non-toxic salt of thecompounds that has a low degree of solubility in body fluids, forexample, (a) an acid addition salt with a polybasic acid, such asphosphoric acid, sulfuric acid, citric acid, tartaric acid, tannic acid,pamoic acid, alginic acid, polyglutamic acid, naphthalene mono- ordi-sulfonic acids, polygalacturonic acid, and the like; (b) a salt witha polyvalent metal cation, such as zinc, calcium, bismuth, barium,magnesium, aluminum, copper, cobalt, nickel, cadmium and the like, orwith an organic cation formed from e.g., N,N′-dibenzyl-ethylenediamineor ethylenediamine; or (c) combinations of (a) and (b), e.g., a zinctannate salt. Additionally, the compounds of the present invention or,preferably, a relatively insoluble salt, such as those just described,can be formulated in a gel, for example, an aluminum monostearate gelwith, e.g., sesame oil, suitable for injection. Particularly preferredsalts are zinc salts, zinc tannate salts, pamoate salts, and the like.Another type of slow release depot formulation for injection wouldcontain the compound or salt dispersed for encapsulation in a slowdegrading, non-toxic, non-antigenic polymer, such as a polylacticacid/polyglycolic acid polymer for example as described in U.S. Pat. No.3,773,919. The compounds or, preferably, relatively insoluble salts,such as those described above, can also be formulated in cholesterolmatrix silastic pellets, particularly for use in animals. Additionalslow release, depot or implant formulations, e.g., gas or liquidliposomes, are known in the literature (U.S. Pat. No. 5,770,222 and“Sustained and Controlled Release Drug Delivery Systems”, J. R. Robinsoned., Marcel Dekker, Inc., N.Y., 1978).

Having generally described the invention, the same will be more readilyunderstood by reference to the following examples, which are provided byway of illustration and are not intended as limiting.

Indications

Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic systemic inflammatory diseasewith autoimmune features. A number of the features of RA may beexplained through an action of dysregulated IL-6.

IL-6 actions of potential relevance in RA include induction ofpolyclonal hypergammaglobulinemia and autoantibody production(rheumatoid factor), through the actions of IL-6 as a B celldifferentiation factor; the promotion of cytotoxic T cell development,in concert with IL-2; the production of acute phase proteins (CRP, SAA,fibrinogen), through hepatocyte stimulating activity; osteoclastactivation, leading to periarticular osteoporosis and bone destruction;the induction of thrombocytosis, through action as megakaryocytedifferentiation factor; and regulation of VEGF, and thereforepotentially angiogenesis, in concert with IL-1β and TNFα.

IL-6 is produced by RA synovial fibroblasts stimulated by TNFα or IL-1,and is present at high concentration in both synovial fluid (SF) andserum in RA. Correlations exist between serum levels andclinical/laboratory indices of disease activity.

Anti-IL-6/IL-6R mAbs were studied in several clinical studies inpatients with active RA. Results to date are briefly described below.

Phase I/II Studies

In the first of these studies, a murine anti-IL-6 mAb (BE-8) wasadministered daily for 10 consecutive days in 5 patients with RA and wasassociated with transitory clinical and laboratory improvement (9)(Wendling, D; et al. 1993 J. Rheumatol. 20:259). The humanizedanti-IL-6R (80 kDa) mAb (MRA; Chugai) was tested in several phase I/IIstudies in patients with RA. In the first of these, MRA was administeredby IV infusion at doses of 1-50 mg once or twice a week, withmaintenance treatment of 50 mg per week for up to 6 months. Thisresulted in rapid decreases in the acute phase measures, C-reactiveprotein (CRP) and fibrinogen, and in low-grade fever, fatigue, andclinical scores, such as morning stiffness and swollen and tender jointcounts. Also noted were improvements in anemia, thrombocytosis andhypergammaglobulinemia. In a subsequent study, 45 patients were treatedwith a single IV infusion of MRA at a dose of 0.1-10 mg/kg, and resultedin trends of improvement in clinical scores at higher dose levels, plusreductions in acute phase reactants.

Phase II Studies

In the first of these studies, 15 patients were treated with MRA (doselevels 2, 4 or 8 mg/kg biweekly for 24 weeks), and showed ACR20responses in 13/15 at week 24, with normalization of CRP/Serum Amyloid A(SAA). Although there were no major acute safety concerns, up to twothirds of patients showed markedly increased LDL cholesterol levels. Ina second phase II study, 164 patents with RA resistant to DMARDs weretreated with placebo or MRA by IV infusion (dose levels 4 or 8 mg/kg,given every 4 weeks for 3 months), and showed ACR20 response rates atweek 12 of 11%, 57%, and 78% for placebo, 4 and 8 mg/kg, respectively.Finally, 359 patients with active RA received MTX alone (10-25 mg/week),MRA alone (dose levels 2, 4 or 8 mg/kg, administered monthly by IVinfusion) or MTX plus MRA. MRA and MRA+MTX were more effective than MTXalone, as determined by ACR20 response.

Systemic Lupus Erythematosus (SLE)

SLE is a chronic, potentially fatal, autoimmune disease with multipleprotean manifestations. The etiology is unknown. One hallmark of thedisease involves B cell hyperproliferation, activation, and autoantibodyproduction against a variety of self-antigens.

IL-6 induces B cells to differentiate into antibody forming cells. InSLE, there is increased production of autoantibodies (ANA, anti-dsDNA)by these antibody forming cells and immune complex deposition. IL-6promotes cytotoxic T cell development, increases hepatic acute phasereactants, mesangial cell proliferation, keratinocyte growth,megakaryocytic differentiation and thrombosis.

IL-6 levels are elevated in both SLE patients and murine SLE models. Itwas demonstrated that IL-6 receptor binding on B cells induces terminaldifferentiation of B cells into autoantibody producing cells.Linker-Israeli et al. (Linker-Israeli M et al., 1991 J Immunol 147:117-123) have shown decreases in spontaneous polyclonal antibodyproduction when neutralizing antibodies against IL-6 were used. Kitaniand others (Kitani A, et al., 1992 Clin Exp Immunol 88: 75-83) supportedthese findings by demonstrating that in vitro T cell production of IL-6doubled in SLE cultures and that SLE B cells had five fold more IL-6production than control B cells. However, the pathologic production ofautoantibodies in SLE is not solely limited to the effects of IL-6. Therole of the IL-6 receptor has been studied also. Nagafuchi and othersshowed IL-6 receptor up regulation in the majority of SLE B cells vs.normal B cells. Anti-IL-6 receptor antibody inhibited terminaldifferentiation of these B cells into antibody forming cells. The roleof the soluble IL-6 receptor in SLE has yet to be determined.

Type II Diabetes Mellitus (T2DM)

Insulin resistance (impaired insulin action) and impaired β-cellfunction (functional deficit of pancreatic β-cells to secrete insulin)are considered to be the main causes of T2DM development. Insulinresistance is manifested as an inability of peripheral tissues torespond adequately to insulin challenge, thus causing an increase inblood glucose levels. The increase in insulin resistance and bloodglucose levels is followed by compensatory hyper-secretion of insulin bypancreatic β-cells in the early stages of the disease. As T2DMprogresses, the ability of β-cells to secrete insulin deteriorates.

The underlining mechanisms responsible for the development of insulinresistance are unclear. The one condition most commonly associated withthe development of T2DM is obesity and even a modest weight losssignificantly improves glucose levels in patients with T2DM.

Both obesity and insulin resistance/hyperinsulinemia, in combinationwith dyslipidemia, impaired glucose tolerance and hypertensioncharacterized the condition called Metabolic Syndrome. The naturalprogression of Metabolic Syndrome to T2DM predisposes individuals todevelopment of micro- and macro-vascular changes that may lead tocardiovascular (CV) disease and ultimately death. Obesity, insulinresistance, and hyper-insulinemia have been suggested to be the mostlikely links between T2DM and CV disease.

Adipose tissue has been identified as one of the major organs thatregulates metabolism, being both an energy storage depot and endocrineorgan that secretes numerous molecules involved in insulin sensitivityregulation. In addition to leptin, resistin, adiponectin, and TNFα,adipose tissue secretes IL-6, which has been suggested to represent thelink between obesity, inflammation, T2DM and cardiovascular (CV)disease.

A positive correlation between adiposity and IL-6 levels has beendocumented. It is possible that increased adipose tissue in obesity mayprovide sustained increases in circulating IL-6 that could decreaseinsulin sensitivity by promoting inflammation in insulin-responsivetissues or cause insulin resistance by interfering with activity andexpression of proteins involved in the insulin-signaling cascade. Bothin vitro and in vivo data that support or oppose the potential role ofIL-6 in the development of insulin resistance exist.

In vitro data using well-defined cell systems including liver(HepG2)(44), fat (3T3L1) or isolated rat pancreatic islet cells show adirect negative effect of IL-6 on insulin signaling, glucose uptake andinsulin secretion, respectively. On the other hand, data obtained fromexperiments done on skeletal muscle biopsies suggest that IL-6 mayincrease glucose uptake in exercising muscle.

In vivo data on the association between IL-6 levels and insulinsensitivity are equally mixed. Models of IL-6 over-expression orcomplete ablation suggest that complete inhibition of IL-6 activitymight not have a beneficial effect. For example, in transgenic non-obesediabetic (NOD) mice, over-expression of human IL-6 delays the onset ofdiabetes and prolongs survival. In addition, data from IL-6 null micesuggest that IL-6 may play a role in energy balance regulation sincethese animals develop late-onset obesity and higher glucose levels.

In humans, a naturally occurring mutation within the region of the IL-6promoter leads to an increase in IL-6 secretion rate. This mutation hasbeen associated with both an increase and a decrease in insulinsensitivity.

In another set of experiments, the effect of exogenous IL-6 has beenevaluated. In normal subjects, IL-6 administration led to increases inglucose levels without affecting plasma insulin concentrations, whereas,in cancer patients, addition of IL-6 increased glucose disposal. Inaddition, the correlation between IL-6 levels and insulin resistance hasbeen examined. Data from these experiments suggested that in both menand women, higher circulating levels of IL-6 were correlated with higherinsulin resistance although a cause-and-effect relationship remains tobe determined.

IL-6 has been indicated to play an important role in the development ofobesity-associated insulin resistance. However, conflicting in vitro andin vivo data exist that both support or oppose its potential role ininsulin resistance.

Osteoarthritis (OA)

OA is a chronic, degenerative joint disorder, characterized by loss ofarticular cartilage, and related changes in subchondral bone. Althoughvarying degrees of inflammation are observed on arthroscopy or insynovial biopsy specimens, the disease is not primarily inflammatory.Rather, it is thought to originate from changes in chondrocyte and/orosteoblast metabolism. TNF, IL-1 and IL-6 are the cytokines moststrongly associated with these changes.

IL-6 is detectable in synovial fluid from patients with OA, although atlevels substantially below those seen in inflammatory arthropathies(Bertazzolo, N. et al. 1994 Agents and Actions 41: 90-92). IL-6 isrecognized to be a primary stimulus for hepatic acute phase proteinsynthesis, and CRP levels are associated with the presence of knee OA,even after taking into account the known association between CRP andobesity (Mohtai, M. et al. 1996 J Orthopedic Research 14: 67-73).

IL-6 is expressed in chondrocytes from OA cartilage, but not normalcartilage (Sowers, M. et al. 2002 Osteoarthritis and Cartilage 10:595-601). In experiments testing the effects of mechanical stress onchondrocyte cytokine expression in vitro, fluid induced shear stressmarkedly upregulated IL-6 mRNA and protein. This suggests that IL-6expression in OA cartilage may result from mechanical loading. IL-6 mayalso be produced in response to IL-1 action on chondrocytes (Dozin, B.et al. 2002 Matrix Biology 21: 449-459).

In other experiments, IL-6, in combination with sIL-6R, led toinhibition of proteoglycan synthesis by human articular chondrocytescultured ex vivo, although the effect was modest compared with IL-1(Guerre, P. et al. 1999 Matrix Biology 18: 253-260).

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a disease state characterized by airflow limitation that is notfully reversible. The airflow limitation is usually progressive andassociated with abnormal inflammatory response of the lungs to noxiousparticles and gases (Pauwels R A et al. 2001 Am. J. Respir Crit Care Med163:1256-1276). COPD is characterized by acceleration in the normaldecline in lung function seen with aging. The slowly progressive airflowlimitation leads to disability and premature death. COPD is a leadingcause of death and disability, but has only recently been extensivelyexplored from a cellular and molecular perspective (Barnes P. J. et al.2003 Eur Respir J 22:672-688). In COPD, there is a chronic inflammationthat leads to fixed narrowing of small airways and alveolar destruction(emphysema). The inflammatory response is characterized by an increasednumber of alveolar macrophages, neutrophils and cytotoxic T-lymphocytesand the release of multiple inflammatory mediators (chemokines,cytokines, growth factors and lipids). A high level of oxidative stressmay amplify the inflammation. There is also increased elastolysis andevidence for involvement of several elastolytic enzymes. Theinflammation and proteolysis in COPD is an amplification of the normalinflammatory response to cigarette smoke. In contrast to asthma, theinflammation appears to be resistant to corticosteroids (Barnes P. J. etal. 2003).

In animal models, bacterial endotoxin or lipopolysaccharides (LPS) andcigarette smoke exposure induce neutrophilia and increased production ofIL-6 in the bronchioalveolar lavage (BAL) fluid (Underwood D.C. et al.2000 AJPLCMP 279:L895-902). Over-expression of IL-6 in mouse lungsinduces emphysema (Kuhn III Ch. et al. 2000 AJRCMB 22:289-295). Inhumans, forced expiratory volume in one second (FEV1) is inverselycorrelated with IL-6, IL-8 levels and polymorphonuclear cell counts inthe BAL (Soler N. et al. 1999 Eur Respir J 14:1015-1022). Plasma TNFα,IL-6 and CRP levels are increased in subjects with mild to severe COPD(Yasuda N. et al. 1998 Respir Med 92:993-999).

Acute exacerbation of COPD is defined as sustained worsening of thepatient's condition, from the stable state and beyond normal day-to-dayvariations, that is acute in onset and necessitates a change in regularmedication (Burge S. et al. 2003 Eur Respir J 21: Suppl. 41, 46s-53s).Although increased symptoms and worsening of lung function are a commoncause of hospital admission (approximately 500,000 each year in the US),the underlying cellular and molecular mechanisms have not been widelyinvestigated and are poorly understood (Wedzicha, J. A. 2002 Chest 121:136S-141S). Acute exacerbations may be prolonged and have profoundeffect on quality of life and may accelerate the progression of COPD(Soto F. J. et al. 2003 Pulm Med 9:117-124). Respiratory infections arethe most common causes of COPD exacerbations. The majority of theseinfections are caused by bacteria, but many of them are due to viralinfections, particularly rhinovirus (Soto F. J. et al. 2003).Environmental factors, air pollutants and temperature may also play arole.

During exacerbation, there is an increase in neutrophils andconcentrations of IL-6, IL-8, TNFα and LTB4 in sputum of patients withCOPD. Some patients with moderate-to-severe COPD are prone to frequentexacerbations (three or more exacerbations per year). This group ofpatients (“frequent exacerbators”) has a higher level of IL-6 and alower level of secretory leukocyte protease inhibitor even when COPD isstable (Bhowmik A. et al. 2000 Thorax 55: 114-120; Gompertz S. et al.2001 Thorax 56: 36-41; Gompertz S. et al. 2001 Eur Respir J 17:1112-1119).

A number of other mechanisms, such as oxidative stress and bacterialcolonization, have been implicated in the pathophysiology of COPDexacerbation as well.

Example 1: Cloning and Expression of IL-6 Antibody in Mammalian Cells

A typical mammalian expression vector contains at least one promoterelement, which mediates the initiation of transcription of mRNA, theantibody coding sequence, and signals required for the termination oftranscription and polyadenylation of the transcript. Additional elementsinclude enhancers, Kozak sequences and intervening sequences flanked bydonor and acceptor sites for RNA splicing. Highly efficienttranscription can be achieved with the early and late promoters fromSV40, the long terminal repeats (LTRS) from retroviruses, e.g., RSV,HTLVI, HIVI and the early promoter of the cytomegalovirus (CMV).However, cellular elements can also be used (e.g., the human actinpromoter). Suitable expression vectors for use in practicing the presentinvention include, for example, vectors, such as pIRES1neo, pRetro-Off,pRetro-On, PLXSN, or pLNCX (Clonetech Labs, Palo Alto, Calif.), pcDNA3.1(+/−), pcDNA/Zeo (+/−) or pcDNA3.1/Hygro (+/−) (Invitrogen), PSVL andPMSG (Pharmacia, Uppsala, Sweden), pRSVcat (ATCC 37152), pSV2dhfr (ATCC37146) and pBC12MI (ATCC 67109). Suitable mammalian and other host cellsinclude human Hela, 293, H9 and Jurkat cells, mouse NIH3T3 and C127cells, Cos 1, Cos 7 and CV 1, quail QC1-3 cells, mouse L cells andChinese hamster ovary (CHO) cells. Alternatively, the gene can beexpressed in stable cell lines that contain the gene integrated into achromosome. The co-transfection with a selectable marker, such as dhfr,gpt, neomycin, or hygromycin, allows the identification and isolation ofthe transfected cells.

The transfected gene can also be amplified to express large amounts ofthe encoded antibody. The DHFR (dihydrofolate reductase) marker isuseful to develop cell lines that carry several hundred or even severalthousand copies of the gene of interest. Another useful selection markeris the enzyme glutamine synthase (GS) (Murphy, et al., Biochem. J.227:277-279 (1991); Bebbington, et al., Bio/Technology 10:169-175(1992)). Using these markers, the mammalian cells are grown in selectivemedium and the cells with the highest resistance are selected. Thesecell lines contain the amplified gene(s) integrated into a chromosome.Chinese hamster ovary (CHO) and NSO cells are often used for theproduction of antibodies.

The expression vectors pC1 and pC4 contain the strong promoter (LTR) ofthe Rous Sarcoma Virus (Cullen, et al., Mol. Cell. Biol. 5:438-447(1985)) plus a fragment of the CMV-enhancer (Boshart, et al., Cell41:521-530 (1985)). Multiple cloning sites, e.g., with the restrictionenzyme cleavage sites BamHI, XbaI and Asp718, facilitate the cloning ofthe gene of interest. The vectors contain in addition to the 3′ intron,the polyadenylation and termination signal of the rat preproinsulingene.

Cloning and Expression in CHO Cells.

The vector pC4 can be used for the expression of IL-6 antibody. PlasmidpC4 is a derivative of the plasmid pSV2-dhfr (ATCC Accession No. 37146).The plasmid contains the mouse DHFR gene under control of the SV40 earlypromoter. Chinese hamster ovary or other cells lacking dihydrofolateactivity that are transfected with these plasmids can be selected bygrowing the cells in a selective medium (e.g., alpha minus MEM, LifeTechnologies, Gaithersburg, Md.) supplemented with the chemotherapeuticagent methotrexate. The amplification of the DHFR genes in cellsresistant to methotrexate (MTX) has been well documented (see, e.g., F.W. Alt, et al., J. Biol. Chem. 253:1357-1370 (1978); J. L. Hamlin and C.Ma, Biochem. et Biophys. Acta 1097:107-143 (1990); and M. J. Page and M.A. Sydenham, Biotechnology 9:64-68 (1991)). Cells grown in increasingconcentrations of MTX develop resistance to the drug by overproducingthe target enzyme, DHFR, as a result of amplification of the DHFR gene.If a second gene is linked to the DHFR gene, it is usually co-amplifiedand over-expressed. It is known in the art that this approach can beused to develop cell lines carrying more than 1,000 copies of theamplified gene(s). Subsequently, when the methotrexate is withdrawn,cell lines are obtained that contain the amplified gene integrated intoone or more chromosome(s) of the host cell.

High efficiency promoters other than the strong promoter of the longterminal repeat (LTR) of the Rous Sarcoma Virus can also be used for theexpression, e.g., the human β-actin promoter, the SV40 early or latepromoters or the long terminal repeats from other retroviruses, e.g.,HIV and HTLVI. Clontech's Tet-Off and Tet-On gene expression systems andsimilar systems can be used to express the IL-6 antibody in a regulatedway in mammalian cells (M. Gossen, and H. Bujard, Proc. Natl. Acad. Sci.USA 89: 5547-5551 (1992)). For the polyadenylation of the mRNA, othersignals, e.g., from the human growth hormone or globin genes, can beused as well. Stable cell lines carrying a gene of interest integratedinto the chromosomes can also be selected upon co-transfection with aselectable marker, such as gpt, G418 or hygromycin. It is advantageousto use more than one selectable marker in the beginning, e.g., G418 plusmethotrexate. The plasmid pC4 is digested with restriction enzymes andthen dephosphorylated using calf intestinal phosphatase by proceduresknown in the art. The vector is then isolated from a 1% agarose gel.

The DNA sequence encoding the complete IL-6 antibody is used, e.g., aspresented in SEQ ID NOS: 98 and 96, corresponding to HC and LC variableregions of an IL-6 antibody of the present invention, respectively,according to known method steps. Isolated nucleic acid encoding asuitable human constant region (i.e., HC and LC regions) is also used inthis construct.

The isolated variable and constant region encoding DNA and thedephosphorylated vector are then ligated with T4 DNA ligase. E. coliHB101 or XL-1 Blue cells are then transformed and bacteria areidentified that contain the fragment inserted into plasmid pC4 using,for instance, restriction enzyme analysis.

Chinese hamster ovary (CHO) cells lacking an active DHFR gene are usedfor transfection. 5 micrograms of the expression plasmid pC4 arecotransfected with 0.5 microgram of the plasmid pSV2-neo usinglipofectin. The plasmid pSV2neo contains a dominant selectable marker,the neo gene from Tn5 encoding an enzyme that confers resistance to agroup of antibiotics including G418. The cells are seeded in alpha minusMEM supplemented with 1 microgram/ml G418. After 2 days, the cells aretrypsinized and seeded in hybridoma cloning plates (Greiner, Germany) inalpha minus MEM supplemented with 10, 25, or 50 ng/ml of methotrexateplus 1 microgram/ml G418. After about 10-14 days, single clones aretrypsinized and then seeded in 6-well petri dishes or 10 ml flasks usingdifferent concentrations of methotrexate (50 nM, 100 nM, 200 nM, 400 nM,800 nM). Clones growing at the highest concentrations of methotrexateare then transferred to new 6-well plates containing even higherconcentrations of methotrexate (1 mM, 2 mM, 5 mM, 10 mM, 20 mM). Thesame procedure is repeated until clones are obtained that grow at aconcentration of 100-200 mM. Expression of the desired gene product isanalyzed, for instance, by SDS-PAGE and Western blot or by reverse phaseHPLC analysis.

Example 2—Construction and Screening of Anti-IL-6 Antibodies

Variants of the IL-6 antibody (clone AME-A9) were constructed andscreened for activity. In this example and otherwise herein, the CDRsare as defined by Kabat with the exception of CDRH1 which is the sum ofKabat and Chothia definitions. The length of CDRH2 made it necessary toconstruct two separate libraries to cover the entire region. Clones ofinterest were sequenced and further characterized by ELISA and in a cellbased assay and kinetic constants were determined.

An example of an ELISA done with the purified IgGs is shown in FIG. 9.The ELISA generally used Costar 3366 microtiter plates coated with agoat anti-human kappa antibody. Dilutions of Fab (or IgG) were incubatedin the coated wells for 1 hr at 22° C. The wells were then washed withPBS, 0.1% Tween 20 and biotinylated IL-6 at 200 ng/ml was added for 1hour. After washing, an alkaline phosphatase conjugate of NeutrAvidinwas added and incubated for 1 hour at 22° C. A colorimetric substratewas added after extensive washing and the bound IL-6 was determined. Avariation of this ELISA included an extended wash step in a beaker ofPBS, 0.01% BSA at 37° C. after the biotinylated IL-6 incubation, e.g.,an 18 hour extended wash step.

Several of the generated human engineered IL-6 reactive IgG monoclonalantibodies of the invention have affinity constants between 1×10⁹ and9×10¹². The high affinities of these human engineered monoclonalantibodies make them suitable for therapeutic applications inIL-6-dependent diseases, pathologies or related conditions.

Multiple different human engineered anti-IL-6 antibody variants wereobtained by altering one or more of the CDR regions of the antibody.Table 3 below shows a summary of the beneficial mutations that werefound in the individual CDR libraries (amino acid changes are relativeto the AME-A9 variant). In addition, Table 13 below shows the amino acidsequences for the light and heavy chain CDRs with the possiblesubstitution positions (marked as “X”).

A “combinatorial” library was constructed based on the best clones(i.e., variants) found in the individual CDR libraries. Table 4 liststhe mutations that were included in the “combinatorial” library. Thecombinatorial library was screened and characterized as described above.The mutations found in six of the better clones are shown in Table 5Abelow, while the sequence ID numbers for the CDRs in these clones areshown in Table 5B.

Assaying Anti-IL-6 IgGs in a Cell-Based Assay

The chimeric anti-IL-6 and human engineered anti-IL-6 (clone AME-19a)antibodies were tested for the ability to prevent the growth of an IL-6dependent cell line. 7TD1 cells were plated into a Costar 3610 96 wellplate at 200 cells per well. Antibodies, diluted in IMDM media, wereadded to the wells followed by the addition of human IL-6 to a finalconcentration of 500 μg/ml and plates were incubated in a tissue cultureincubator for 64-72 hours. At that time, 50 μl of cell lysis buffer fromthe ATPlite kit (Packard Bioscience) were added to all wells and theplates were agitated for 3 minutes. 50 μl of ATPlite substrate wereadded and the covered plates were shaken for 1 minute. Chemiluminescencewas determined on a luminometer.

The results of a cell-based assay are shown in FIG. 10, with thecalculated EC₅₀ values shown in Table 6 below. The EC₅₀ value of thechimeric anti-IL-6 antibody is 2.7×10⁻¹¹ M (4.09 ng/ml) and that of thehuman engineered anti-IL-6 (clone AME-19a) antibody is 2.7×10⁻¹² M (0.41ng/ml). The EC₅₀ value of the human engineered antibody shows about a10-fold improvement, although it may be possible to obtain from about a10-fold up to about a 60-fold improvement, including intervening values,in the EC₅₀ value.

Example 3—Binding Kinetics of Human Engineered Anti-Human IL-6Antibodies

ELISA analysis confirms that purified antibody from these host cellsbind IL-6 in a concentration-dependent manner. In this case, theaffinity of the antibody for its cognate antigen (epitope) is measured.Quantitative binding constants are obtained using BIAcore analysis andthe KinExA 3000 instrument. The results indicate that several of thehuman engineered monoclonal antibodies are very high affinity with K_(D)in the range of 1×10⁻⁹ to 3×10⁻¹⁴.

An enzyme immunoassay (EIA) that uses anti-human IL-6 monoclonalantibodies (AME-A9, AME-A16, AME-18a, AME-20b, AME-22a, and AME-23a) andCNTO 328 used as a positive control to detect the bound IL-6 to thesoluble IL-6 receptor, sIL-6R, was performed. The soluble human IL-6receptor, sIL-6R, and recombinant human IL-6 were obtained from R&DSystems (Minneapolis, Minn.) (Catalog #227-SR-025 and 206-IL-010,respectively). Goat anti-human IgG-horseradish peroxidase-linked (H+Lchain) was obtained from Jackson Immunoresearch (West Grove, Pa.)(Catalog #109-035-003). Hydrogen Peroxide and OPD tablets were obtainedfrom Sigma (St. Louis, Mo.) (Catalog #H-1009 and P-8287, respectively).

Enzyme Linked Immunoassay for Sgp80/IL-6/Anti-IL-6 mAb Complex Formation

Costar EIA plates (Corning/Costar, Acton, Mass.) (Catalog #9018) werecoated with sIL-6R (10 μg/ml in PBS, 100 μl/well) overnight at 4° C. Theplates were washed with 0.15M saline containing 0.02% (v/v) Tween 20 andwells were blocked with 1% (w/v) BSA in PBS, 200 μl/well for one hour atroom temperature. The wells were washed again then in the sequentialformat incubated with 200 ng/ml human IL-6 (100 μl/well) in PBS for onehour at room temperature. Antibody was added to all wells in 10-foldserial dilutions from a starting concentration of 10 μg/ml in 100μl/well for one hour at room temperature. After washing, the wells wereincubated with goat anti-human IgG (H+L)-HRP-linked, (10 μg/ml in PBS)for 30 minutes at room temperature. The wells were washed and 100μl/well of citrate-phosphate substrates solution (0.1M Citric Acid and0.2M Sodium Phosphate, 0.01% H₂O₂ and 1 mg/ml OPD) was added for 15minutes at room temperature. The reaction was stopped by addition of 25μl/well of 4N sulfuric acid and the OD490 was read via an automatedELISA plate reader (Molecular Devices Spectromax Plus, Sunnyvale,Calif.).

To test the effect of preincubation of IL-6 with anti hIL-6 monoclonalantibodies or CNTO 328, 200 ng/ml IL-6 (100 μl) was incubated withten-fold serial dilutions of antibody (100 μl), starting with 10 μg/mlfor one hour at room temperature. This pre-incubated mixture was thenincubated with sIL-6R for one hour at room temperature and detection ofthe sIL-6R/IL-6/anti human IL-6 complex was detected using goatanti-human IgG (H+L)-HRP-linked, (10 μg/ml in PBS) for 30 minutes atroom temperature. The remainder of the assay conditions was the same asdescribed in the previous paragraph.

Previous studies have shown that CNTO 328 can detect IL-6 when it iscaptured by sIL-6R that is coated on an EIA plateinternal technicalreport. In addition, AME-A9, AME-A16, AME-18a, AME-20b, AME-22a, andAME-23a can detect IL-6 bound to sgp80 (sIL-6R) in a dose dependentmanner using EIA. Each human engineered anti-IL-6 antibody was evaluatedin reference to CNTO 328. However, preincubation of IL-6 and any ofthese anti hIL-6 monoclonal antibodies precludes the ability of sIL-6Rto bind IL-6.

Measuring Kinetic Constants for Anti-IL-6 IgGs

The KinExA 3000 instrument, manufactured by Sapidyne, was used tomeasure binding kinetics. Briefly, human IL-6 was covalently coupled toalzactone beads and the binding of free IgG to the beads was detected onthe instrument. To measure K_(D), individual tubes containing a constantconcentration of either 0.5, 1 or 5 pM of IgG with decreasing seriallydiluted human IL-6, were incubated for 3-4 days at 20° C. in 0.1% BSA,PBS. A total of 13 tubes were used for each K_(D) determination. Forexample, the chimeric anti-IL-6 antibody was used at a constantconcentration of 5 pM and individual tubes were incubated with 0-200 pMof IL-6. Incubations for the other IgGs were set in a similar manner.After the incubation, free IgG in each equilibrated sample wasdetermined on the KinExA 3000 instrument according to the manufacturer'sinstructions. K_(D) values were determined by the KinExA 3000 softwareusing the KinExA 3000 instrument, as described in more detail below.

To measure k_(on), individual IgGs at 200 pM were mixed with 100-200 pMof human IL-6 and the unbound IgG was detected by binding to human IL-6covalently coupled to alzactone beads on the KinExA 3000 instrument. Aseries of measurements were taken over time. The resulting data was usedto calculate the k_(on), with the KinExA 3000 software. k_(off) wascalculated by using the formula K_(D)=k_(off)/k_(on). A summary of thekinetic constants for the anti-IL-6 IgGs is shown in Table 7.

Example 4: In Vitro Characterization of Anti-IL-6 Antibody

In vitro studies were conducted to characterize the sequence, epitopespecificity, affinity, and biologic activity of the anti-IL-6 antibody.

Human Engineered mAb

Sequence analysis confirms that the anti-IL-6 antibody of the presentinvention (embodied in different variants/clones) contains fully humanframeworks. Table 5a shows a total of 10 amino acid residues changed inboth the heavy and light chains of CDR1, 2, and 3 in the anti-IL-6antibody of the present invention (in different variants of theantibody) as compared with the chimeric anti-IL-6 antibody (described inPCT WO 04/039826).

Epitope Specificity

The anti-IL-6 antibody of the present invention and the chimericanti-IL-6 antibody recognize a similar epitope on human IL-6. Theseantibodies do not compete with the commercial mouse anti-human IL-6 mAbfrom R&D Systems #MAB-206 suggesting that they recognize an epitope thatis uniquely different from that of the R&D anti-IL-6 mAb. The anti-IL-6antibody of the present invention and the chimeric anti-IL-6 antibody donot compete with R&D rat anti-human IL-6 mAb.

Human IL-6 (200 ng/ml) was captured by plate-bound anti-IL-6 mAb (mouseanti-human IL-6 mAb, MAB-206, which was used only as plate bound mAb tocapture human IL-6) (10 μg/ml) and serial dilutions of the anti-IL-6antibody of the present invention and the chimeric anti-IL-6 antibody,as indicated along the X-axis were then added to the plate. Binding toIL-6 was measured as increase in OD₄₉₀ along the Y-axis. Both theanti-IL-6 antibody of the present invention and the chimeric anti-IL-6antibody show dose-dependent binding to IL-6.

Conversely, the anti-IL-6 antibody of the present invention and thechimeric anti-IL-6 antibody competitively bind for human IL-6,suggesting that the two molecules share a similar binding epitope onIL-6. Human IL-6 (200 ng/ml) was captured by plate-bound MAB-206 (10μg/ml). Serial dilutions of the anti-IL-6 antibody of the presentinvention as indicated along the X-axis and 50 ng/ml of biotinylatedchimeric anti-IL-6 antibody were then added to the plate. Binding ofbiotinylated chimeric anti-IL-6 antibody to IL-6 was detected bystreptavidin-HRP and measured as OD₄₉₀ readings along the Y-axis.

Moreover, the human engineered and chimeric antibodies exhibit similarproperties for binding to the sIL-6/sIL-6R complex (FIG. 1). Theanti-IL-6 antibody of the present invention binds to sIL-6/SIL-6Rcomplex. Soluble IL-6 receptor (sIL-6R) was coated on the plate at 10μg/ml concentration. Human IL-6 was then added to the plate at 200 ng/mlconcentration. Serial dilutions of the anti-IL-6 antibody of the presentinvention or the chimeric anti-IL-6 antibody, as indicated along theX-axis, were then added to the plate and binding to the IL-6/sIL-6Rcomplex was detected using HRP-anti-human IgG and measured as OD₄₉₀readings along the Y-axis.

To further confirm the above findings, cross-species reactivity testingwas conducted using IL-6-containing conditional supernatant generatedfrom LPS and IFNγ-stimulated PBMCs of different species in a 7TD1 (IL-6dependent murine hybridoma cell line) cell-based proliferation assay.The human engineered antibody of the invention was shown to neutralizethe activity of the conditioned supernatants in stimulating 7TD1 cellproliferation from a variety of primate species, including human,marmoset, cynomolgus monkey, chimpanzee, rhesus monkey, baboon, pigtailmonkey, and cotton top monkey, and displayed a similar cross-speciesreactivity pattern compared with the chimeric antibody (Table 8).

Finally, when epitope mapping was conducted using the tryptic digestmethod, the same binding epitope for the human engineered and chimericantibodies on human IL-6 was observed and is located on the Helix Dspanning amino acid residues 168-184 (FIG. 3). Recent mutationalanalysis confirmed that residues 179 and 182 are essential for theantibody of the invention to bind to IL-6. The epitope (amino acidresidues 168-184) was identified as the surface of IL-6 that retaineddeuterium in the presence of human engineered anti-IL-6 antibody.

Biologic Activity

The IL-6 neutralization potency of human engineered anti-IL-6 antibodywas determined by 7TD1 cell-based bioassay. Human engineered anti-IL-6antibody demonstrated a 10-fold higher neutralization potency ascompared with chimeric anti-IL-6 antibody in the 7TD1 cell proliferationassay. 7TD1 cells were stimulated with 500 pg/ml of hIL-6 in thepresence of serial dilutions of human engineered anti-IL-6 antibody orchimeric anti-IL-6 antibody or isotype control mAb for 72 hours. Cellproliferation was measured as counts per second as indicated on theY-axis. Error bars indicate the SD of duplicate samples. A closed circleindicates cells without IL-6; open circle indicates cells stimulatedwith 500 μg/ml of hIL-6.

Human engineered anti-IL-6 antibody also inhibits IL-6-induced monocytechemoattractant protein-1 (MCP-1) production from U937 cells (FIG. 3)and IL-6/IL-1β-induced serum amyloid A (SAA) production from HepG2 humanhepatoma cells (FIG. 4). FIG. 3 demonstrates that human engineeredanti-IL-6 antibody inhibits IL-6 stimulated MCP-1 secretion from U937cells. 5×10⁵ cells/well were treated with 1 ng/ml of hIL-6 and serialdilutions of human engineered anti-IL-6 antibody for 72 hours. Cellculture supernatants were analyzed in triplicates by ELISA for thepresence of MCP-1.

FIG. 4 shows that the human engineered anti-IL-6 antibody inhibits IL-6and IL-1β stimulated SAA secretion from HepG2 cells. 2.25×10⁵cells werestimulated with 100 ng/ml of hIL-6, 200 ng/ml of sIL-6R and 1 ng/ml ofIL-1β in the presence of serial dilutions of human engineered anti-IL-6antibody for 24 hours. Cell culture supernatants were then analyzed induplicates by ELISA for the presence of SAA.

IL-6 Dependent Stat3 Phosphorylation

To assess the ability of human engineered anti-IL-6 antibody to blockthe signaling cascade resulting from IL-6 binding to IL-6R and gp130, animmuno-precipitation assay was performed to test the effect on IL-6dependent STAT3 phosphorylation in THP-1 cells, which express gp130 onthe cell surface.

The mAbs are sterile-filtered filter-sterilized and stored in PBS at 4°C. Recombinant human IL-6 (206-IL-010) and sIL-6R (227-SR-025) from R&DSystems (Minneapolis, Minn.) were used. RPMI media (11875-085),heat-inactivated fetal bovine serum (16000-069), L-Glutamine(25030-081), non-essential amino acids (11140-050), and sodium pyruvate(11360-070) were obtained from Invitrogen (Carlsbad, Calif.). TBS (10 mMTris, pH7.5, 100 mM NaCl) was also used.

THP-1, a human acute monocytic leukemia cell line received from researchcell banks, was tested to be mycoplasma negative and bacteria free.These cells were cultured in RPMI media containing 10% fetal bovineserum, 2 mM glutamine, and 1 mM sodium pyruvate. Cells were subculturedor harvested when cultures reached approximately 85% confluence. Cellswere routinely split 1:5 every three days.

For tyrosine phosphorylation, cells were grown to 80-90% confluence inT-225 flasks. The media was removed and replaced with fresh mediawithout serum and incubated for overnight. Following serum starvation,cells were harvested from each flask, pelleted and a final concentrationof 20×10⁶ cells per condition was resuspended in 0.5 ml media withoutserum.

RhIL-6 (0.1 μg/ml) was pre-incubated at 37° C. for 15 minutes with thefollowing reagents: 0.5 ml media alone, anti-IL-6 Ab (10 μg/ml); andsIL-6R (0.2 μg/ml). SIL-6R (0.2 μg/ml) and anti-IL-6 Ab (10 μg/ml) werethen added to cells preincubated with anti-IL-6 Ab and sIL-6R,respectively, for incubation at 37° C. for 15 minutes. The cells werethen combined with medium as negative control and the IL-6/Ab/sIL-6Rcomplex and incubated at 37° C. for 6 minutes. The cells were washedtwice in ice-cold TBS and cell pellets were either processed asdescribed in Section 5.4 or stored at −70° C.

For immunoprecipitation, the cell pellets were lysed in 1 ml lysisbuffer (50 mM Tris, pH7.5, 300 mM NaCl, 0.5% Triton-X-100) (T-9284,Sigma, St. Louis, Mo.) containing complete protease inhibitor cocktailtablet (1697498, Roche, Basel, Switzerland). The cells were vortexed for30 seconds and incubated at −70° C. for 20-60 minutes. Cellular debriswas removed by centrifugation at 13,000 rpm for 20 minutes. To reducenon-specific background staining, the samples were pre-cleared byincubation with 2 μg rabbit IgG (15006, Sigma, St. Louis, Mo.) plus 50μl Protein A agarose (SC-2001, Santa Cruz Biotechnology, Santa Cruz,Calif.) for 1 hr at 4° C. on an orbital mixer. The agarose beads wereremoved by centrifugation at 2500 rpm for 5 minutes. The cleared lysateswere transferred to microcentrifuge tubes and incubated with anti-STAT3(2 μg/ml) (SC-7179, Santa Cruz Biotechnology) overnight at 4° C. on anorbital mixer, followed by addition of 50μ Protein A agarose beads andincubated for 2 hours at 4° C. on an orbital shaker. The agarose beadswere collected by centrifugation at 2500 rpm for 5 minutes and washed 5times in ice-cold TBS at 4° C. The agarose beads were then resuspendedin 40 μl Laemmli sample buffer plus DTT (NP0007-465030, Invitrogen,Carlsbad, Calif.) and heated at 95° C. for 5 minutes.

The samples were resolved on a 3-8% NuPage Bis-Tris gel (EA0375BOX,Invitrogen, Carlsbad, Calif.) with running buffer (NP0002-465026,Invitrogen, Carlsbad, Calif.) at 100 V for 1 hour. The proteins weretransferred to a Nitrocellulose membrane (LC2001, Invitrogen, Carlsbad,Calif.) using transfer buffer (NP0006-465029, Invitrogen, Carlsbad,Calif.) at 30 V for 1 hour. The membranes were blocked in 10% fat freedry milk (Nestle, Glendale, California) in TBS-T for overnight at 4° C.Following several washes in TBS-T at room temperature, the membraneswere incubated with mouse monoclonal anti-p-STAT3 Ab (SC-8059, SantaCruz Biotechnology, Santa Cruz, Calif.), which was diluted 1:1000 inTBS-T for 4 hrs at 4° C. on an orbital shaker. After several washes, themembranes were then incubated with donkey anti-mouse IgG-HRP (1:1000)(SC-2318, Santa Cruz Biotechnology, Santa Cruz, Calif.) at roomtemperature for 2 hr on an orbital mixer. After several washes, thesamples were detected using ECLplus Western Blot Detection Reagents andanalysis kit (RPN2108, Amersham Biosciences, Piscataway, N.J.) followingmanufacturer's protocol and visualized by exposure to ECL film. Themembranes were then stripped of Ab by submerging in 100 mM DTT, 2% SDS,62.5% mM Tris-HCl, pH 6.7 at 100° C. for 30 minutes with agitation. Themembranes were then washed in TBS-T and blocked overnight with the 10%fat free dry milk. The membranes were washed and incubated withanti-STAT3 (1:1000) (SC-7179, Santa Cruz Biotechnology) in TBS-T for 2hours at 4° C., washed 5 times followed by a 1 hour incubation with goatanti-rabbit IgG-HRP (1:1000) (SC2030, Santa Cruz Biotechnology, SantaCruz, Calif.) and detected using ECLplus. All membranes were routinelystripped and reprobed with STAT3 to demonstrate the presence of STAT3protein.

The results showed that human engineered anti-IL-6 antibody blockedIL-6-mediated stat3 phosphorylation, a key component in the IL-6signaling pathway (FIGS. 5A and 5B). Human engineered anti-IL-6 antibody(AME-19A) inhibits IL-6/sIL-6R-induced stat3 phosphorylation.Recombinant human IL-6/sIL-6R-induced stat3 phosphorylation was detectedin THP-1 cells (FIG. 5B). The addition of 10 μg/ml of human engineeredanti-IL-6 antibody (AME-19A) or chimeric anti-IL-6 antibody completelyinhibited stat3 phosphorylation (FIG. 5B). FIG. 5A shows the presence ofa similar amount of unphosphorylated stat3 protein in all samplescorresponding to the different human engineered anti-IL-6 clones. Asused herein, CNT0328 (or 328) designates the chimeric, human-murineantibody (also referred to as wild type (WT)), 150 designates cloneAME-22a, 143 designates clone AME-23a, 140 designates clone AME-20b, 136designates clone AME-19a, 130 designates clone AME-18a, 106 designatesclone AME-A16, 104 designates clone AME-A9.

In Vivo Efficacy of Human Engineered Anti-IL-6 Antibody

The efficacy of human engineered anti-IL-6 antibody was assessed in twodifferent in vivo models. First, the effects of human engineered andchimeric anti-IL-6 antibody were tested and compared in a humanIL-6-induced Matrigel angiogenesis assay in mice. 200 ng/ml of humanIL-6 was included in the Matrigel plug. Two Matrigel plugs were injectedinto each nude mouse. Groups of six mice received an i.v. injection of1, 3, or 6 mg/kg of human engineered or chimeric anti-IL-6 antibody. PBSor an isotype control mAb was also administered for control groups.Plugs were removed on day 7 and angiogenesis was measured by hemoglobincontent, microvessel length, and microvessel number in the plugs.Results showed that human IL-6 (PBS group) stimulated angiogenesis inthe Matrigel plug model as measured by all three parameters.

Human engineered anti-IL-6 antibody (AME-19A) inhibits the mean numberof microvessels in Matrigel plugs. In addition, human engineeredanti-IL-6 antibody (AME-19A) inhibits mean length of microvessels inMatrigel plugs. Also, human engineered anti-IL-6 antibody (AME-19A)inhibits hemoglobin level in Matrigel plugs.

In addition, both human engineered (AME-19A) and chimeric anti-IL-6antibody dose-dependently inhibited IL-6-mediated angiogenesis in nudemice. Finally, human engineered and chimeric anti-IL-6 antibodyexhibited comparable activity in inhibiting IL-6-induced angiogenesis at6 mg/kg, the highest dose tested. Although chimeric anti-IL-6 antibodysignificantly inhibited human IL-6-induced angiogenesis at 3 mg/kg asmeasured by vessel length and vessel number, no statisticallysignificant differences were detected between human engineered andchimeric anti-IL-6 antibody at these doses.

An additional in vivo model was developed to further evaluate the effectof human engineered anti-IL-6 antibody on human IL-6-induced acute phasereactant, serum amyloid protein A (SAA) production in Balb/C mice. Micereceived an i.p. administration of 0.01, 0.5 or 5 mg/kg of humanengineered anti-IL-6 antibody 4 hours prior to an i.v. administration of5 μg/kg of human IL-6 (FIG. 6). PBS and isotype control mAb were used ascontrols. Serum SAA levels were determined at 16 hours post-IL-6injection. Both human engineered and chimeric anti-IL-6 antibodysignificantly inhibited human IL-6-induced SAA production in Balb/C miceat 0.5 and 5 mg/kg, and human engineered anti-IL-6 antibodysignificantly inhibited SAA production at the lowest dose tested.However, no statistically significant differences were observed betweenhuman engineered and chimeric anti-IL-6 antibody at all three dosestested (FIG. 6).

FIG. 6 shows that human engineered anti-IL-6 antibody inhibits humanIL-6-induced SAA production. Each point represents the mean value of SAAfor each animal and the line represents the mean of all the data pointsin each group. Pair-wise comparison was conducted and Tukey's 95%simultaneous confidence intervals were used in order to control theoverall type I error. (** p<0.001, *p<0.05).

Example 5—Therapeutic Rationale for Anti-IL-6 mAb

Rheumatoid Arthritis. Effect of Anti-IL-6 mAb on Collagen InducedArthritis (CIA)—an Animal Model of Rheumatoid Arthritis

Preclinical In Vivo Disease Models

IL-6 has been targeted in a variety of in vivo models. Either ratanti-mouse IL-6 antibody was used in standard murine models or humanizedanti-IL-6R (80 kDa) mAb (MRA; Chugai) was used in primate models and inthe human/mouse SCID model. In murine collagen induced arthritis (CIA),anti-IL-6 was effective in preventing disease if used early (day 0 or 3post immunization with collagen), but not at later time points. In thehuman/mouse SCID transplant model, in which human synovial tissue istransplanted into immunodeficient mice, MRA treatment led to shrinkageof tissue implants and reduced inflammatory cells and osteoclasts. InCIA in cynomolgus monkeys, MRA inhibited development of arthritis, andimproved acute phase measures.

The effect of a surrogate anti-mouse IL-6 mAb on disease development hasbeen evaluated in a CIA model. The results indicate that i.p.administration of anti-mouse IL-6 at 1 mg/mouse/week prior to diseaseinduction significantly suppressed the development of collagen-inducedarthritis as reflected by the marked reduction in disease severity.Arthritis was induced in 8-week old DBA/1 LacJ mice with 100 μg ofbovine type II collagen in Freund's complete adjuvant (FCA)intradermally at the base of the tail. Mice were clinically monitoreddaily for the onset of disease. Anti-IL-6 mAb or isotype control mAb wasadministered i.p. 2 days prior to CIA induction and weekly thereafter at1 mg/mouse. The arthritis score was determined based on swelling,erythema, and disfiguration of the joint.

The histopathological data confirmed the clinical observation thatweekly i.p. injection of anti-mouse IL-6 mAb significantly improved theparameters of collagen induced arthritis. All of the parameters ofarthritis examined including the inflammatory response (synovitis andpannus formation) and the erosive changes (erosions and overall jointarchitecture) were significantly improved in anti-mouse IL-6 treatedmice as compared with control mAb-treated animals. The anti-IL-6 mAbsuppressed arthritis at a histopathological level. Synovitis was scoredbased on the thickness of the synovial membrane; pannus formation wasscored based on the extent of pannus relative to joint space; anderosions were scored based on the extent into the cartilage andsubchondral bone.

The loss of cartilage matrix proteins was significantly reduced in micetreated with anti-mouse IL-6 mAb. Representative joint sections obtainedfrom control and anti-IL-6 mAb treated animals at the end of the study(day 53) were examined by Toluidine Blue staining for cartilage matrix.

Micro-CT analysis supported the clinical observation that the effect ofanti-mouse IL-6 therapy was exerted at the level of the progression ofdisease within the individual joint. Visual inspection of typical 3D CTimages indicates the marked degree of erosive changes that occur in theisotype control mAb-treated group as compared with the predominantlymild soft tissue inflammatory changes in joints from anti-mouse IL-6treated animals. The experiments were performed with representativeanimals treated with control mAb and anti-mouse IL-6 mAb treatedanimals.

Lupus. Effect of Anti-IL-6 in NZB/W F1 Mice

Pre-Clinical In Vivo Disease Models

Murine models exist for SLE and these have close similarities to humandisease. Studies of MRL/lpr and NZB/W F1 strains demonstrated B cellhyperproliferation, autoantibody production, and immune complexdeposition that closely resemble the human disease. Anti-IL-6 mAb wasshown to be effective in inhibiting autoantibody production, reducingproteinuria, and improving animal survival in NZB/W F1 mice.

The effect of a surrogate anti-mouse IL-6 mAb on lupus diseasedevelopment has been evaluated in NZB/W F1 mice. The preliminary resultsdemonstrated that i.p. administration of anti-mouse IL-6 mAb at 1mg/mouse/week for 22 weeks suppressed the production of anti-dsDNAautoantibody, a major pathogenic autoantibody in this disease model(FIG. 7). Anti-dsDNA autoantibody levels in anti-IL-6 mAb treatedanimals were consistently lower throughout the study as compared to thatin saline and control Ab treated animals.

As discussed above, FIG. 7 shows the inhibition of anti-dsDNAautoantibody production by anti-IL-6 mAb in NZB/W F1 mice. An IndividualO.D. value for each sample was normalized to a positive control serumand presented as % positive control. Each point represents the %positive control of each sample and the line represents the mean of allthe data points in each group. Significant difference is indicated as *p<0.01.

In addition, anti-IL-6 mAb inhibited B-cell proliferation and reducedkidney damage when a small subset of the animals was examined. Whilethere was no significant difference in T cell proliferation among thedifferent treatment groups at the end of the study, B-cell proliferationinduced by anti-IgM and anti-CD40 was lower in anti-IL-6 mAb treatedmice compared with that of saline-treated mice over time, specifically,after 34 weeks. This result is consistent with the reduced anti-dsDNAautoantibody production reported above and suggests that autoreactive Bcells might be the direct and dominant targets for anti-IL-6 mAbtreatment.

Histopathological analysis indicated that animals in the study could becategorized into 3 kidney disease severity groups (mild, moderate, andsevere) (Table 9). The renal disease pathology in NZB/W F1 mice indicatemixed lymphoid hyperplasia and immune complex deposition in theglomerular basement membrane.

Animals treated with anti-IL-6 mAb developed less severe kidney disease.Perivascular mixed lymphoid hyperplasia and protein deposition wereabsent in the anti-IL-6 mAb treated animals while animals treated withsaline and control Ab developed moderate and severe perivascular mixedlymphoid hyperplasia and protein deposition. Furthermore, immune complexdeposition in the glomerular basement membrane was mild in the anti-IL-6mAb treated animals as compared with that in the other two treatmentgroups. Further dissection of the mechanism of action of anti-IL-6 mAbon B, T, and macrophage cell functions is performed as these cells playcritical roles in the pathogenesis of SLE.

Type II Diabetes Mellitus

IL-6 has been indicated to play an important role in development ofinsulin resistance associated with obesity. However, in vitro and invivo data generated to date both support and oppose its potential rolein insulin resistance.

In Vitro Experiments

Experiments have been performed to better understand the effects thatIL-6 may have on insulin signaling and on the biological effects andfunction of insulin, such as glucose up-take, gene regulation, andrelated mechanisms using in vitro models of insulin responsive tissues(3T3 L1 cells for adipose tissue, HepG2 cells for hepatic cells, C2C12cells for skeletal muscle) and in vivo models of insulin resistance andT2DM, such as db/db mice.

The in vitro data suggest that IL-6 exerts its primary effect on insulinsignaling in the liver. IL-6 treatment of HepG2 cells leads to theinhibition of insulin induced Akt phosphorylation. This inhibitoryeffect of IL-6 on insulin signaling is blocked by an anti-IL-6 antibody.Changes in glucose metabolism and insulin effects in the liver have beensuggested to be driving causes of the development of insulin resistanceand T2D. The effects of IL-6 on insulin signaling in 3T3 L1 cells(adipocyte cell line) and C2C12 (skeletal muscle cell line) are examinedto determine mechanisms of IL-6 in T2D.

3T3 L1.

Experiments were conducted using 3T3 L1 mouse adipocyte cell line. In90% differentiated 3T3 L1 cells, the effect of IL-6 on insulin inducedglucose uptake was evaluated. In these experiments, treatment with 10ng/ml of TNFα for 24 hours consistently inhibits insulin induced glucoseuptake while 20 ng/ml of IL-6 did not have any effect. These datasuggest that IL-6 activity on adipose tissue is not the primarymechanism of IL-6 mediated insulin resistance, but rather adipose tissuemay be a main source of IL-6 that then interferes with insulinsensitivity in liver and muscle. The same data were obtained usingdifferentiated primary human adipocytes from subcutaneous depot. TheIL-6 effects on glucose uptake using human primary adipocytes from avisceral fat depot is tested because that depot could be more relevantfor obesity associated insulin resistance.

HepG2.

HepG2 cells were chosen as an in vitro representative of liver tissue.HepG2 cells are human hepatoma cell line where the effect of IL-6 oninsulin signaling has been previously shown. In the experiments, 20ng/ml of IL-6 blocked the insulin induced Akt phosphorylation, a crucialkinase in insulin signaling pathway, with the maximum effect beingobserved after 60 minutes of incubation; this is consistent with resultsreported in the scientific literature.

Akt phosphorylation on sub-confluent HepG2 cells in 10 cm dishes wasmeasured after rh IL-6 (20 ng/ml) incubation for 30, 60, 90 and 120minutes. During the last 5 minutes of incubation, 0.5 nM, 1 nM and 5 nMinsulin were added to induce Akt phosphorylation. Cells were lysed usingmodified RIPA lysis buffer and Akt phosphorylation was measured usingSer-Phospho-Akt ELISA. Results were obtained using pAkt and Akt ELISAkits (BioSource). At 60 minutes of IL-6 treatment, in the presence of aphysiological concentration of insulin (0.5-1 nM), Akt phosphorylationwas inhibited ˜50% compared to the control group. Protein concentrationswere quantitated with the Pierce BCA protein assay kit.

Effect of IL-6 Antibody

The ability of human engineered anti-IL-6 antibody to inhibit IL-6effects on insulin-induced Akt-phosphorylation was measured. 20 μg/ml ofhuman engineered anti-IL-6 antibody was able to inhibit the IL-6 effectsin HepG2 cells. FIGS. 8A and 8B show the effect of IL-6 in the presenceand absence of human engineered anti-IL-6 antibody on insulin inducedAkt phosphorylation.

In the top image (FIG. 8A), data represent mean+/−SEM. (* Significantcompared to (+) insulin, IL-6, P=0.029; ** Significant compared to (+)insulin+IL-6, P=0.02). Sub-confluent HepG2 cells were treated with 20ng/ml of IL-6 for 60 minutes. During the last 5 minutes of treatment, 1nM insulin was added and cells were lysed using modified RIPA buffer.Samples were analyzed by ELISA that detects phosphorylation at Ser 473of Akt. All data were normalized to total Akt measured by ELISA. AME-19atreatment was able to restore normal Akt signaling.

In the bottom image (FIG. 8B), a representative western blot is shown.Top bands include samples treated with IL-6 (20 ng/ml, 60 min, 5 minwith 1 nM insulin), AME-19a (20 ug/ml+/−IL-6 at 20 ng/ml for 60 minutes,5 minutes with 1 nM insulin) or buffer. Blot was probed withanti-phospho Ser/Akt antibody (upper panel) (pS473, Biosource). Thelower bands (the same blot was stripped and reprobed with anti-Akt fromBioSource) demonstrate that equivalent protein was loaded per lane.

Method:

HEPG2 cells were grown in 100 mm tissue culture dishes until confluency.Cells were starved overnight in DMEM-1% BSA. AME-19a (20 ug/ml) wasincubated on cells for ˜30 minutes prior to IL-6 addition. IL-6 (20ng/ml)+/−AME-19a (20 ug/ml) were incubated for ˜30 minutes prior toaddition to cells. Samples were incubated on cells for 60 minutes, at37° C.; then 1 nM insulin (final concentration) was added to cells for 5minutes, at room temperature. Cells were washed immediately with 3rinses of ice cold PBS. Plates were frozen until lysis. Phospho Akt andtotal Akt were determined using ELISA kits (BioSource and Sigma).Reference: J J Senn, P J Kover, I A Nowak and R A Mooney. Interleukin 6induces cellular insulin resistance in hepatocytes. Diabetes.51:3391-3399, 2002.

Primary Rat Hepatocytes

Primary hepatocytes represent a more relevant in vitro system suitablefor testing the effect of IL-6 and anti-IL-6 antibodies (or other IL-6antagonists) on insulin signaling and the insulin effect on liverglucose production. To determine PI3 kinase (PI3K) activation in rathepatocytes treated by insulin, IL-6 and/or IL-6 mAb, isolated cellswere treated with insulin in the presence and absence of 5 ng/ml IL-6,and the phosphorylation of the insulin receptor, IRS-1 (FIG. 12A), andAkt (FIG. 12B) was determined using ELISA assays and Western blotanalysis. In addition, the effects of IL-6 on insulin stimulatedIRS1/p85 association were examined (FIGS. 11A and B). The experimentswere performed as follows:

Primary rat hepatocytes (˜2 months old) in 6 well collagen coated plateswere equilibrated overnight in Hepatoczyme media. On the next day, cellswere starved for 6 hours in DMEM-1% BSA-penn strep; then incubated withhIL-6 (5 ng/ml); anti-IL-6 antibody (AME-19a) (20 ng/ml) or anti-IL-6antibody (AME-19a)+hIL-6 for 90 minutes at 37° C. Cells were pretreatedfor 1 hour with anti-IL-6 antibody (AME-19a) prior to addition of thecombination. The combination was also preincubated prior to addition tothe cells. 5 nM of insulin (from BioSource) was added to cells for 5minutes; then cells were aspirated and lysed immediately with BioSourceextraction buffer+protease inhibitors. Lysates were centrifuged and thesupernatants were diluted 1:10 and tested in ELISAs (from Biosource).

IRS1/p85 Association:

Equal amounts of protein (45 μg) were incubated overnight with 2 μg ofanti-IRS-1 polyclonal antibody (from Upstate, Item #06-248). The sampleswere than immunoprecipitated with protein A beads for 1 hour and elutedwith 3× sample buffer for SDS-PAGE. The IP samples were than run on4-12% SDS-Page gel and then transferred to membrane for Western blotanalysis. The membranes were probed with: (1) 1:100 diluted p85 mAb(from Upstate, Item #05-217) for IRS-1 associated p85, i.e., the activePI3K (as shown in FIG. 11A); and (2) 1:600 diluted IRS-1 mAb (from BDBiosciences, Item #611395) for total IRS-1 as a loading control (asshown in FIG. 11B).

The data indicate that IL-6 treatment leads to a decrease ofinsulin-induced phosphorylation of IR, IRS-1 and Akt. This effect ofIL-6 was abolished when cells were pretreated with anti-IL-6 antibody(clone AME-19a). In addition, IL-6 inhibited insulin induced p85(subunits of PI3K) association with IRS-1. Again, this effect of IL-6was inhibited by pretreatment with anti-IL-6 antibody.

In Vivo Experiments

The effects of IL-6 on insulin sensitivity have not been extensivelytested in animals. In order to evaluate whether anti-IL-6 therapy wouldimprove insulin sensitivity and T2DM, db/db mice and C57/B16 males on ahigh fat diet have been treated with commercial anti-mouse IL-6 antibody(obtained from R&D Systems).

Db/Db Mice

The effects of anti IL-6 treatment are tested using db/db mice ofdifferent ages. Mice between 8-10 weeks of age are characterized byhyperinsulinemia and insulin resistance, thus representing earlierstages of the disease, while mice 12-14 weeks of age are characterizedby elevated glucose levels in addition to hyperinsulinemia, thusrepresenting advanced stages of T2DM. Both age groups of mice are usedto test the ability of anti IL-6 therapy to improve insulin sensitivityand glycemic control in intraperitoneal glucose tolerance test (ipGTT).

The db/db mice have non-functional leptin signaling due to the mutationwithin the leptin receptor. These mice develop obesity, hyperinsulinemiaand insulin resistance as the mice age, with the first symptoms beingdetected when the mice are 6-8 weeks old. Two groups of mice ofdifferent ages—8 and 12 weeks old—have been treated with 5 mg/kg of antiIL-6 mAb and an intraperitoneal glucose tolerance test (ipGTT) wasperformed one day and 7 days post treatment. The treatment schedule isshown in FIG. 15.

In 8-week old animals, treatment with anti IL-6 mAb did not have aneffect on glucose clearance during GTT. Anti IL-6 mAb treatment lead toimprovement in glucose tolerance (GT) in 12 week old animals, althoughthe effect was not statistically significant (p=0.063). This improvementin GTT was seen at day 7 post treatment. In addition, serum samplesbefore and after the completion of the study were analyzed for theiradipokine and adiponectin profiles. The levels of IL-6, TNFα and MCP-1were below the detection levels. This data taken together with resultsfrom ipGTT may suggest that: db/db animals are not a good model to studyanti IL-6 effects on insulin resistance; and tissue levels of IL-6 aremore relevant for a possible role that IL-6 may play in development ofinsulin resistance and T2DM.

Diet Induced Obesity (DIO)—Animal Model for Obesity and InsulinResistance

C57/B1 male mice were fed a diet comprising 60% fat for 20-35 weeks.They developed obesity (average body weight was 50.5 grams) and anincrease in fasting blood glucose levels (FBG >145 mg/dl). In addition,they have impaired GT. DIO animals were treated with 10 mg/kg of murineanti IL-6 Ab (R&D Systems). Overall, they received 50 mg/kg of anti IL-6mAb over the period of 3 weeks. ipGTT was performed after the first 2doses (day 5), after the 4th dose (days 12 and 16) and after the 5thdose (day 23). At the same time, blood was obtained for measurements ofadipocytokines and adiponectin.

Anti IL-6 treatment did not improve glucose tolerance at days 5 and 12;however, when performed at days 16 and 23, an improvement in glucoseclearance as well as in levels of glucose excursion were observed. Thisimprovement reached statistical significance at 39, 60 and 90 minutesduring GTT.

In another set of experiments, DIO animals were treated weekly (2 dosesduring the first week and 1 dose each week for the subsequent 4 weeks)with 10 and 20 mg/kg of anti IL-6 Ab and 20 mg/kg IgG isotype controlvia i.p route. HOMA-IR (after 2, 4 and 6 weeks of treatment), ipGTT,ipITT and adipokine profile (at 6 weeks of treatment) have beenperformed.

HOMA-IR Analysis on Anti-IL-6 Ab Treated DIO Animals:

In these studies, there was a decrease in fasting blood glucose andinsulin levels in DIO animals treated with 10 and 20 mg/kg of murineanti-IL-6 Ab and isotype control. Animals were bleed and fasting glucoseand insulin levels were determined using Trace/DMA glucose (ox) (thermoElectron Corp) and Ultra Sensitive Rat Insulin Elisa (Crystal Chem),respectively. These values were used to determine HOMA-IR. The HOMA-IRindex reflects the status of insulin sensitivity and it correlates wellwith the finding from the clamp study. HOMA-IR is calculated by theformula: (Fasting glucose (mM)×fasting Insulin (mIU/Lit))/22.5 (FIGS.13A, B and C).

The improvements in HOMA-IR were observed after 2, 4 and 6 weeks oftreatment (FIGS. 13A-C show the data after 6 weeks of treatment). At theend of the study, ipGTT and ipITT were performed. In both tests,anti-IL-6 treatment (20 mg/ml) significantly improved both glucoseexcursion and clearance when compared to isotype treated animals.

Adipokine and cytokine analysis of serum samples from control andanti-IL-6 treated animals indicated that IL-6 neutralization lead to adecrease in circulating IL-6 and TNFα levels along with the decreasedtrend of MCP-1 and resistin levels. In another set of data, adiponectinlevels were increased with anti-IL-6 treatment.

Histological analysis of liver samples from the treatment and controlgroups was performed. The samples were stained with Oil Red O stainingto determine the lipid content in the liver parenchyma. The liver lipidcontent in the DIO animals was reduced in response to treatment by themurine anti-IL-6 antibody.

The staining reveals that 34% of vehicle treated liver sample were lipidrelated in untreated animals and only 8% in 20 mg/kg anti-IL-6 treatedanimals (FIGS. 14A-F). FIGS. 14A and D represent the control group;FIGS. 14B and E represent the untreated DIO animals; and FIGS. 14C and Frepresent the anti-IL-6 treated animals. The increased lipid livercontent has been associated with development of insulin resistance andType 2 Diabetes Mellitus. Thus, it is conceivable that IL-6neutralization lead to the improvement in insulin sensitivity and T2DMby affecting liver lipid metabolism. These data taken together stronglysuggest the role of IL-6 in the pathology of Type 2 Diabetes and thatneutralization of IL-6 could improve insulin sensitivity.

Additional Studies

The effects of IL-6 in the presence or absence of human engineeredanti-IL-6 antibody on insulin stimulated IRS1 phosphorylation,association with p85/PI3K, insulin receptor (IR) phosphorylation,glycogen syntheses, and the involvement of SOCS3 and STAT signaling inHepG2 cells are monitored. Additional experiments examine the effect ofIL-6 on glucose induced insulin secretion from pancreatic islets. Thedata published to date describe both inhibitory as well as stimulatoryeffects of IL-6 on insulin secretion from rat islets. Freshly isolatedrat islets (from Liefscann) are treated with IL-6 and human engineeredanti-IL-6 antibody (AME-19a) in the presence or absence of glucose.Levels of insulin secreted from islets under various treatments aremeasured.

C2C12.

C2C12 cells are used to study the effect of insulin on skeletal muscle.Experiments to examine IRS1 and Glut4 expression, insulin induced IRS 1phosphorylation, and the effects of IL-6 on adiponectin action areperformed.

Advantages:

Inhibition of IL-6 activity by the IL-6 antibody of the presentinvention could represent a significant therapeutic advance since itwill be able to improve insulin sensitivity and metabolic controlwithout the side effects of existing agents. In addition, currenttherapies do little to control systemic inflammation, which is suggestedto be the underlining cause of T2DM, associated diabetic complications.A therapeutic like the IL-6 antibody of the present invention, inaddition to increasing insulin sensitivity, would be expected to inhibitsystemic inflammation and prevent development of diabetic complications.

The number of patients affected by T2DM is growing and it is estimatedto extend to 300 million individuals by 2025. An anti IL-6 antibodycould be used as a monotherapy or in combination with other alreadyexisting OAD, such as sulphonylureas, biguanides (e.g., Metphormin),thiazolidinediones, meglitinide (e.g., repaglinide), alpha-glucosidaseinhibitors (e.g., acarbose). In addition, it could be used incombination with insulin or other therapeutics, such as to improveinsulin sensitivity and glycemic control and avoid hypoglycemic eventsthat are associated with insulin treatment. It is also expected that inaddition to improvement of insulin sensitivity and regulation of glucoselevels in T2D and Metabolic Syndrome patients, anti IL-6 therapy wouldhave a beneficiary effect on CV changes often observed in thesepatients. See Saltiel, A R, and Kahn, C R. 2001. Nature 414:799-806;Hansen, B C., 1995. Diabetes Care 18:A2-A9; Diabetes Prevention Programresearch group. 2002. New Engl. J Med., 346:393-403; Hansen, B C., 2000,Ann New York Academy of Science, 892:1-24; Hsueh, W A., and Quinones, MJ., 2003, Am. J. Cardiology, 93: 10J-17J; Resnick, H E and Howard, B V.,2002, Ann. Rev. Med., 53:245-267; Korner, J. and Aronne, L., 2003, JClin. Invest., 111(5):565-570; Skoog, T., et al., 2001. Diabetologia,44:654:655; Fernandez-Real, J M., and Ricart W., 2003, EndocrineReviews, 24(3):278-301; Fernandez-Real, J M., et al., 2001, J ClinEndocrinol Metab., 86:1154-1159.; 10a. Fried, S., et al., 1998. J ClinEndocrinol Metab., 83:847-850; Senn, J J., et al., 2002, Diabetes,51:3391-3399; Rotter, V., et al, 2003, JBC in press, Manus. #301977200;12a. Stouthard, J M., et al., 1996, BBRC, 220:241-245; Southern, C., etal., 1990, Biochem J., 272:243-245; Sandler, S., et al., 1990,Endocrinology, 126:1288-1294; Pedersen, B K., et al., 2001, J Physiol.,536:329-337; DiCosmo, B F, et al., 1994, Int. Immunol., 6:1829-1837;Wallenius, V., et al., 2002, Nature Medicine, 8:75-79; Vozarova, B., etal., 2003, Human Genetic, 112:409-413; Kubaszek, A., et al., 2003,Diabetes, 52:558-461; Tsigos, C., et al., 1997, J Clin Endocrinol Metab,82:4167-4170; Stoutharad, J M., et al., 1995, Am J Physiol., 268;E813-E819; Kern, P A., et al., 2001, Am J Physiol Endocrinol Metab.,280:E745-E751; Bastard, J P., et al., 2000, J Clon Endocrinol Metab.,85:3338-3342; and Bastard, J P., et al, 2002, J. Clin. Endocrinol.Metab., 87:2084-2089.

It will be clear that the invention can be practiced otherwise than asparticularly described in the foregoing description and examples.Numerous modifications and variations of the present invention arepossible in light of the above teachings and, therefore, are within thescope of the appended claims.

TABLE 1 Light Chain CDRs SEQ ID CDR NO Name* Clone Sequence SEQ ID CDRL133 SASHSVSYMY NO: 1 SEQ ID CDRL1 33 AGTGCCAGCCATAGTGTAAGTTACATGTAC NO: 2SEQ ID CDRL1 34 SASISVSYMY NO: 3 SEQ ID CDRL1 34AGTGCCAGCATTAGTGTAAGTTACATGTAC NO: 4 SEQ ID CDRL1 35 SARSSVSYMY NO: 5SEQ ID CDRL1 35 AGTGCCCGGTCAAGTGTAAGTTACATGTAC NO: 6 SEQ ID CDRL1 36SASYSVSYMY NO: 7 SEQ ID CDRL1 36 AGTGCCAGCTATAGTGTAAGTTACATGTAC NO: 8SEQ ID CDRL1 37 SASSSVFYMY NO: 9 SEQ ID CDRL1 37AGTGCCAGCTCAAGTGTATTTTACATGTAC NO: 10 SEQ ID CDRL1 39 SGSSYVSYMY NO: 11SEQ ID CDRL1 39 AGTGGCAGCTCATATGTAAGTTACATGTAC NO: 12 SEQ ID CDRL1 40SALSSVSYMY NO: 13 SEQ ID CDRL1 40 AGTGCCCTGTCAAGTGTAAGTTACATGTAC NO: 14SEQ ID CDRL1 A9 SASSSVSYMY NO: 15 SEQ ID CDRL1 A9AGTGCCAGCTCAAGTGTAAGTTACATGTAC NO: 16 SEQ ID CDRL2 41 DFSNLAS NO: 17SEQ ID CDRL2 41 GACTTTTCCAACCTGGCTTCT NO: 18 SEQ ID CDRL2 43 DLSNLASNO: 19 SEQ ID CDRL2 43 GACCTGTCCAACCTGGCTTCT NO: 20 SEQ ID CDRL2 44DMSNLAS NO: 21 SEQ ID CDRL2 44 GACATGTCCAACCTGGCTTCT NO: 22 SEQ ID CDRL246 DTSNLTS NO: 23 SEQ ID CDRL2 46 GACACATCCAACCTGACGTCT NO: 24 SEQ IDCDRL2 48 DTSELAS NO: 25 SEQ ID CDRL2 48 GACACATCCGAGCTGGCTTCT NO: 26SEQ ID CDRL2 A9 DTSNLAS NO: 27 SEQ ID CDRL2 A9 GACACATCCAACCTGGCTTCTNO: 28 SEQ ID CDRL3 49 MQWSGYPYT NO: 29 SEQ ID CDRL3 49ATGCAGTGGAGTGGTTACCCATACACG NO: 30 SEQ ID CDRL3 50 CQWSGYPYT NO: 31SEQ ID CDRL3 50 TGTCAGTGGAGTGGTTACCCATACACG NO: 32 SEQ ID CDRL3 52SCWSGYPYT NO: 33 SEQ ID CDRL3 52 TCTGTGTGGAGTGGTTACCCATACACG NO: 34SEQ ID CDRL3 A9 SQWSGYPYT NO: 35 SEQ ID CDRL3 A9TCTCAGTGGAGTGGTTACCCATACACG NO: 36 SEQ ID CDRL3 Alt. QQWSGYPYT NO: 138*CDRs were as defined by Kabat with the exception of CDRH1 which is thesum of Kabat and Chothia definitions.

TABLE 2 Heavy Chain CDRs CDR SEQ ID NO Name* Clone SequenceSEQ ID NO: 37 CDRH1  4 GFTFSSFALS SEQ ID NO: 38 CDRH1  4GGATTCACCTTTAGTAGCTTTGCCCTTTCT SEQ ID NO: 39 CDRH1  5 GFTFSPFAMSSEQ ID NO: 40 CDRH1  5 GGATTCACCTTTAGTCCTTTTGCCATGTCT SEQ ID NO: 41CDRH1  6 GFQFSSFAMS SEQ ID NO: 42 CDRH1  6GGATTCCAGTTTAGTAGCTTTGCCATGTCT SEQ ID NO: 43 CDRH1  8 GFTTSSFAMSSEQ ID NO: 44 CDRH1  8 GGATTCACCACTAGTAGCTTTGCCATGTCT SEQ ID NO: 45CDRH1 Q + P GFQFSPFAMS SEQ ID NO: 46 CDRH1 Q + PGGATTCCAGTTTAGTCCTTTTGCCATGTCT SEQ ID NO: 47 CDRH1 A9 GFTFSSFAMSSEQ ID NO: 48 CDRH1 A9 GGATTCACCTTTAGTAGCTTTGCCATGTCT SEQ ID NO: 49CDRH2 10 KASSGGSYTYYPDTVTG SEQ ID NO: 50 CDRH2 10AAAGCGAGTAGTGGTGGGAGTTACACCTACTATCCTGA CACTGTGACGGGC SEQ ID NO: 51 CDRH211 KISSGGSYEYYPDTVTG SEQ ID NO: 52 CDRH2 11AAAATTAGTAGTGGTGGGAGTTACGAGTACTATCCTGA CACTGTGACGGGC SEQ ID NO: 53 CDRH212 KISSGGSYYYYPDTVTG SEQ ID NO: 54 CDRH2 12AAAATTAGTAGTGGTGGGAGTTACTATTACTATCCTGA CACTGTGACGGGC SEQ ID NO: 55 CDRH214 KISSGGSWTYYPDTVTG SEQ ID NO: 56 CDRH2 14AAAATTAGTAGTGGTGGGAGTTGGACCTACTATCCTGA CACTGTGACGGGC SEQ ID NO: 57 CDRH216 KISPGGSYTYYPDTVTG SEQ ID NO: 58 CDRH2 16AAAATTAGTCCGGGTGGGAGTTACACCTACTATCCTGA CACTGTGACGGGC SEQ ID NO: 59 CDRH2P + KISPGGSWTYYSDTVTG W + S (18a, 19a) SEQ ID NO: 60 CDRH2 P +AAAATTAGTCCGGGTGGGAGTTGGACCTACTATTCTGA W + S CACTGTGACGGGC (18a, 19a)SEQ ID NO: 61 CDRH2 A9 KISSGGSYTYYPDTVTG SEQ ID NO: 62 CDRH2 A9AAAATTAGTAGTGGTGGGAGTTACACCTACTATCCTGA CACTGTGACGGGC SEQ ID CDRH2 Alt.EISSGGSYTYYPDTVTG NO: 113 SEQ ID NO: 63 CDRH2 17 KISSGGSYTYFPDTVTGSEQ ID NO: 64 CDRH2 17 AAAATTAGTAGTGGTGGGAGTTACACCTACTTTCCTGACACTGTGACGGGC SEQ ID NO: 65 CDRH2 19 KISSGGSYTYYPDTVAG SEQ ID NO: 66CDRH2 19 AAAATTAGTAGTGGTGGGAGTTACACCTACTATCCTGA CACTGTGGCTGGCSEQ ID NO: 67 CDRH2 20 KISSGGSYTYYDDTVTG SEQ ID NO: 68 CDRH2 20AAAATTAGTAGTGGTGGGAGTTACACCTACTATGATGA CACTGTGACGGGC SEQ ID NO: 69 CDRH221 KISSGGSYTYYSDTVTG SEQ ID NO: 70 CDRH2 21AAAATTAGTAGTGGTGGGAGTTACACCTACTATTCTGA CACTGTGACGGGC SEQ ID NO: 71 CDRH222 KISSGGSYTYYPDTVTP SEQ ID NO: 72 CDRH2 22AAAATTAGTAGTGGTGGGAGTTACACCTACTATCCTGA CACTGTGACGCCG SEQ ID NO: 73 CDRH223 KISSGGSYTYYPDTDTG SEQ ID NO: 74 CDRH2 23AAAATTAGTAGTGGTGGGAGTTACACCTACTATCCTGA CACTGATACGGGC SEQ ID NO: 75 CDRH2P + S KISPGGSYTYYSDTVTG (20b, 23a) SEQ ID NO: 76 CDRH2 P + SAAAATTAGTCCGGGTGGGAGTTACACCTACTATTCTGA (20b, CACTGTGACGGGC 23a)SEQ ID NO: 77 CDRH2 P + KISPGGSWTYYDDTVTG W + D (22a) SEQ ID NO: 78CDRH2 P + AAAATTAGTCCGGGTGGGAGTTGGACCTACTATGATGA W + D CACTGTGACGGGC(22a) SEQ ID NO: 79 CDRH3 25 QLWGSYALDY SEQ ID NO: 80 CDRH3 25CAGTTATGGGGGTCGTATGCTCTTGACTAC SEQ ID NO: 81 CDRH3 26 QLWGYYALDTSEQ ID NO: 82 CDRH3 26 CAGTTATGGGGGTACTATGCTCTTGACACG SEQ ID NO: 83CDRH3 29 QLWGTYALDY SEQ ID NO: 84 CDRH3 29CAGTTATGGGGGACTTATGCTCTTGACTAC SEQ ID NO: 85 CDRH3 30 QLWGNYALDYSEQ ID NO: 86 CDRH3 30 CAGTTATGGGGGAATTATGCTCTTGACTAC SEQ ID NO: 87CDRH3 31 QLWGYYALDF SEQ ID NO: 88 CDRH3 31CAGTTATGGGGGTACTATGCTCTTGACTTT SEQ ID NO: 89 CDRH3 32 QLWGYYALDISEQ ID NO: 90 CDRH3 32 CAGTTATGGGGGTACTATGCTCTTGACATT SEQ ID NO: 91CDRH3 A9 QLWGYYALDY SEQ ID NO: 92 CDRH3 A9CAGTTATGGGGGTACTATGCTCTTGACTAC SEQ ID CDRH3 Alt. GLWGYYALDY NO: 114*CDRs were as defined by Kabat with the exception of CDRH1 which is thesum of Kabat and Chothia definitions.

TABLE 3 Mutations from Individual CDR libraries Clone CDRH1 4 M34L 5S31P 6 T28Q 8 F29T CDRH2 10 I51A 11 T57E 12 T57Y 14 Y56W 16 S52aP 17Y59F 19 T64A 20 P60D 21 P60S 22 G65P 23 V63D CDRH3 25 Y99S 26 Y102T 27Y99S 29 Y99T 30 Y99N 31 Y102F 32 Y102I CDRL1 33 S27H 34 S27I 35 S26R 36S27Y 37 S30F 38 S27I 39 A25G, S28Y 40 S26L CDRL2 41 T51F 43 T51L 44 T51M46 A55T 47 T51L 48 N53E CDRL3 49 Q89M 50 Q89C 52 Q90C

TABLE 4 Mutations Included in the Combinatorial Library CDRH1 CDRH2CDRH3 CDRL1 CDRL2 CDRL3 T28Q S52aP Y102F S27I T51F Q89M S31P Y56W Y102IS27Y T51M P60S V63D

TABLE 5A Positive Library Clones Light Heavy CDR--> L1 L2 L3 H1 H2 H3WT--> S T Q T S E S Y P V G Y CNTO328 Clone 27 51 89 28 31 50 52a 56 6063 95 102 AME-A9 S K Q AME-16 S K P Q AME-18a F M Q P K P W S Q IAME-19a I M M P K P W S Q I AME-20b I M M Q K P S Q I AME-22a Y F M Q PK P W D Q F AME-23a Y M M Q K P S Q F

TABLE 5B Human Engineered Anti-IL-6 Antibody Clones and CorrespondingCDRs CDR--> L1 L2 L3 H1 H2 H3 AME-A9 SEQ ID: 15 SEQ ID: 27 SEQ ID: 35SEQ ID: 47 SEQ ID: 61 SEQ ID: 91 AME-16 SEQ ID: 15 SEQ ID: 27 SEQ ID: 35SEQ ID: 47 SEQ ID: 57 SEQ ID: 91 AME-18a SEQ ID: 15 SEQ ID: 17 SEQ ID:29 SEQ ID: 45 SEQ ID: 59 SEQ ID: 89 AME-19a SEQ ID: 3 SEQ ID: 21 SEQ ID:29 SEQ ID: 39 SEQ ID: 59 SEQ ID: 89 AME-20b SEQ ID: 3 SEQ ID: 21 SEQ ID:29 SEQ ID: 41 SEQ ID: 75 SEQ ID: 89 AME-22a SEQ ID: 7 SEQ ID: 17 SEQ ID:29 SEQ ID: 45 SEQ ID: 77 SEQ ID: 87 AME-23a SEQ ID: 7 SEQ ID: 21 SEQ ID:29 SEQ ID: 41 SEQ ID: 75 SEQ ID: 87

TABLE 6 EC₅₀ Values Clone EC50 Value CNTO328 2.7 × 10⁻¹¹ M AME-19a 2.7 ×10⁻¹² M (10-fold improvement)

TABLE 7 Kinetic Constants for Anti-IL-6 IgG's Improvement Antibody Ratio(as k_(on) Concentration K_(D) compared to (M⁻¹ Improvement k_(off)(sec⁻¹) Improvement Clone (pM) (pM) chimeric ab) sec⁻¹) Ratio(calculated) Ratio Chimeric 5 3 1 4.4 × 10⁶ 1 1.3 × 10⁻⁵ 1 antibodyAME-16 1 0.83 3.6   1 × 10⁶ 0.22 8.3 × 10⁻⁷ 15.7 AME-18a 0.5 0.12 25   2× 10⁷ 4.4 2.4 × 10⁻⁶ 5.4 AME-19a 0.5 0.037 81.1 5.5 × 10⁶ 1.2   2 × 10⁻⁷65 AME-20b 1 0.78 3.8 4.7 × 10⁶ 1 3.7 × 10⁻⁶ 3.5 AME-22a 1 0.18 16.7   6× 10⁶ 1.3 1.1 × 10⁻⁶ 11.8 AME-23a 1 0.006 500 7.4 × 10⁶ 1.6 4.4 × 10⁻⁸295

TABLE 8 Cross-species reactivity of Human Engineered and ChimericAntibody Inhibition (Chimeric and Human Species Engineered)Cross-reactive Human + Marmoset + Cynomolgous + Chimp + Rhesus +Baboon + Pig-Tail + Cotton Top + Unknown Rabbit N/D Non-reactive Dog −Mouse − Rat − Guinea Pig − Yucatan mini-pig − Cross-species reactivityof Human Engineered and Chimeric Antibody. The human engineered andchimeric antibodies are able to neutralize the proliferation of 7TD1cells that were stimulated by conditioned supernatants of PBMCs ofhuman, marmoset, cynomolgus monkey, chimpanzee, rhesus monkey, baboon,pigtail monkey, and cotton top monkeys. “+” positive in neutralizationassay; “−” negative in neutralization assay; N/D, not determined.

TABLE 9 Impact of anti-IL-6 mAb treatment on renal pathology in NZB/W F1mice Treatment group Severe* Moderate* Mild* Saline (n = 10) 60% or 6/1020% or 2/10 20% or 2/10 Rat IgG (n = 10) 70% or 7/10 30% or 3/10 0 or0/10 R&D anti-mouse IL-6 10% or 1/10 30% or 3/10 60% or 6/10 (n = 10)*Severe - Perivascular mixed lymphoid hyperplasia, mesangialhypercellularity, protein deposition, glomeruler basement membraneimmune complex deposition Moderate - Moderate perivascular mixedlymphoid hyperplasia, moderate mesangial hypercellularity, glomerulerbasement membrane immune complex deposition, no protein depositionMild - Mild mesangial hypercellularity, mild glomeruler basementmembrane immune complex deposition, no perivascular mixed lymphoidhyperplasia, no protein deposition

TABLE 10 Variable region sequences of clones Heavy (H) or Light (L)SEQ ID Chain V NO Clone Region Sequence 93 A9 L ChainEIVLTQSPATLSLSPGERATLSCSASSSVS AA YMYWYQQKPGQAPRLLIYETSNLASGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCSQW SGYPYTFGGGTKVEIK 94 L ChainGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGA NucleotideAAGAGCCACCCTCTCCTGCAGTGCCAGCTCAAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACACATCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTTCTCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGG ACCAAGGTGGAGATCAAA 95H Chain EVQLVESGGGLVQPGGSLRLSCAASGFTFS AA SFAMSWVRQAPGKGLEWVAKISSGGSYTYYPDTVTGRFTISRDNAKNSLYLQMNSLRAED TAVYYCARQLWGYYALDYWGQGTTVTVSS 96 H ChainGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTC NucleotieCCTGAGACTCTCCTGTGCAGCCTCTGGATTCACCTTTAGTAGCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTAGTGGTGGGAGTTACACCTACTATCCTGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACTACTGGGGCCAAGGGACCACGGTCACCGT CTCCTCA 97 19AL Chain EIVLTQSPATLSLSPGERATLSCSASISVS AA YMYWYQQKPGQAPRLLIYEMSNLASGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCMQW SGYPYTFGGGTKVEIK 98 L ChainGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGA NucleotideAAGAGCCACCCTCTCCTGCAGTGCCAGCATTAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACATGTCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTATGCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGG ACCAAGGTGGAGATCAAA 99H Chain EVQLVESGGGLVQPGGSLRLSCAASGFTFS AA PFAMSWVRQAPGKGLEWVAKISPGGSWTYYSDTVTGRFTISRDNAKNSLYLQMNSLRAED TAVYYCARQLWGYYALDIWGQGTTVTVSS 100 H ChainGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTC NucleotideCCTGAGACTCTCCTGTGCAGCCTCTGGATTCACCTTTAGTCCTTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCGGGTGGGAGTTGGACCTACTATTCTGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACATTTGGGGCCAAGGGACCACGGTCACCGT CTCCTCA 101 23AL Chain EIVLTQSPATLSLSPGERATLSCSASYSVS AA YMYWYQQKPGQAPRLLIYDMSNLASGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCMQW SGYPYTFGGGTKVEIK 102 L ChainGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGA NucleotideAAGAGCCACCCTCTCCTGCAGTGCCAGCTATAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACATGTCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTATGCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGG ACCAAGGTGGAGATCAAA103 H Chain EVQLVESGGGLVQPGGSLRLSCAASGFQFS AASFAMSWVRQAPGKGLEWVAKISPGGSYTYY SDTVTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDFWGQGTTVTVSS 104 H ChainGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTC NucleotieCCTGAGACTCTCCTGTGCAGCCTCTGGATTCCAGTTTAGTAGCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCGGGTGGGAGTTACACCTACTATTCTGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACTTTTGGGGCCAAGGGACCACGGTCACCGT CTCCTCA 116 AME-16L Chain EIVLTQSPATLSLSPGERATLSCSASSSVS AA YMYWYQQKPGQAPRLLIYETSNLASGIPARFSGSGSGTDFTLTISSLEPEDFAVYYCSQW SGYPYTFGGGTKVEIK 117 L ChainATGGAAGCCCCAGCGCAGCTTCTCTTCCTCCTGCTACTCTGGCTCCCAGA NucleotideTACCACCGGAGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGAAAGAGCCACCCTCTCCTGCAGTGCCAGCTCAAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACACATCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTTCTCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGGACCAAGGTGGAGATCAAA 118 H Chain EVQLVESGGGLVQPGGSLRLSCAASGFTFSAA SFAMSWVRQAPGKGLEWVAKISPGGSYTYY PDTVTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDYWGQGTTVTVSS 119 H ChainATGGAGTTTGGCCTGAGCTGGGTTTTCCTTGTTGCTATTTTAGAAGGTGT NucleotideCCAGTGTGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTCCCTGAGACTCTCCTGTGCAGCCTCTGGATTCACCTTTAGTAGCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCCGGTGGGAGTTACACCTACTATCCTGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACTACTGGGGCCAAGGGACCACGG TCACCGTCTCCTCA 120AME-18a L Chain EIVLTQSPATLSLSPGERATLSCSASSSVS AAYMYWYQQKPGQAPRLLIYDFSNLASGIPAR FSGSGSGTDFTLTISSLEPEDFAVYYCMQWSGYPYTFGGGTKVEIK 121 L ChainATGGAAGCCCCAGCGCAGCTTCTCTTCCTCCTGCTACTCTGGCTCCCAGA NucleotideTACCACCGGAGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGAAAGAGCCACCCTCTCCTGCAGTGCCAGCTCAAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACTTCTCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTATGCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGGACCAAGGTGGAGATCAAA 122 H Chain EVQLVESGGGLVQPGGSLRLSCAASGFQFSAA PFAMSWVRQAPGKGLEWVAKISPGGSWTYY SDTVTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDIWGQGTTVTVSS 123 H ChainATGGAGTTTGGCCTGAGCTGGGTTTTCCTTGTTGCTATTTTAGAAGGTGT NucleotideCCAGTGTGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTCCCTGAGACTCTCCTGTGCAGCCTCTGGATTCCAGTTTAGTCCCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCCGGTGGGAGTTGGACCTACTATAGCGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACATTTGGGGCCAAGGGACCACGG TCACCGTCTCCTCA 124AME-20b L Chain EIVLTQSPATLSLSPGERATLSCSASISVS AAYMYWYQQKPGQAPRLLIYDMSNLASGIPAR FSGSGSGTDFTLTISSLEPEDFAVYYCMQWSGYPYTFGGGTKVEIK 125 L ChainATGGAAGCCCCAGCGCAGCTTCTCTTCCTCCTGCTACTCTGGCTCCCAGA NucleotideTACCACCGGAGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGAAAGAGCCACCCTCTCCTGCAGTGCCAGCATTAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACATGTCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTATGCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGGACCAAGGTGGAGATCAAA 126 H Chain EVQLVESGGGLVQPGGSLRLSCAASGFQFSAA SFAMSWVRQAPGKGLEWVAKISPGGSYTYY SDTVTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDIWGQGTTVTVSS 127 H ChainATGGAGTTTGGCCTGAGCTGGGTTTTCCTTGTTGCTATTTTAGAAGGTGT NucleotideCCAGTGTGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTCCCTGAGACTCTCCTGTGCAGCCTCTGGATTCCAGTTTAGTAGCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCCGGTGGGAGTTACACCTACTATAGCGACACTGTGACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACATTTGGGGCCAAGGGACCACGG TCACCGTCTCCTCA 128AME-22a L Chain EIVLTQSPATLSLSPGERATLSCSASYSVS AAYMYWYQQKPGQAPRLLIYDFSNLASGIPAR FSGSGSGTDFTLTISSLEPEDFAVYYCMQWSGYPYTFGGGTKVEIK 129 L ChainATGGAAGCCCCAGCGCAGCTTCTCTTCCTCCTGCTACTCTGGCTCCCAGA NucleotideTACCACCGGAGAAATTGTGTTGACACAGTCTCCAGCCACCCTGTCTTTGTCTCCAGGGGAAAGAGCCACCCTCTCCTGCAGTGCCAGCTACAGTGTAAGTTACATGTACTGGTACCAACAGAAACCTGGCCAGGCTCCCAGGCTCCTCATCTATGACTTCTCCAACCTGGCTTCTGGCATCCCAGCCAGGTTCAGTGGCAGTGGGTCTGGGACAGACTTCACTCTCACCATCAGCAGCCTAGAGCCTGAAGATTTTGCAGTTTATTACTGTATGCAGTGGAGTGGTTACCCATACACGTTCGGCGGAGGGACCAAGGTGGAGATCAAA 130 H Chain EVQLVESGGGLVQPGGSLRLSCAASGFQFSAA PFAMSWVRQAPGKGLEWVAKISPGGSWTYY PDTDTGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCARQLWGYYALDFWGQGTTVTVSS 131 H ChainATGGAGTTTGGCCTGAGCTGGGTTTTCCTTGTTGCTATTTTAGAAGGTGT NucleotideCCAGTGTGAGGTGCAGCTGGTGGAGTCTGGGGGAGGCTTGGTCCAGCCTGGGGGGTCCCTGAGACTCTCCTGTGCAGCCTCTGGATTCCAGTTTAGTCCCTTTGCCATGTCTTGGGTCCGCCAGGCTCCAGGGAAGGGGCTGGAGTGGGTGGCCAAAATTAGTCCCGGTGGGAGTTGGACCTACTATCCTGACACTGACACGGGCCGATTCACCATCTCCAGAGACAACGCCAAGAACTCACTGTATCTGCAAATGAACAGCCTGAGAGCCGAGGACACGGCTGTGTATTACTGTGCGAGACAGTTATGGGGGTACTATGCTCTTGACTTCTGGGGCCAAGGGACCACGG TCACCGTCTCCTCA

TABLE 11 Amino acid sequence of a human light chain framework region L6with interspersed CDR sequences labeled   (FRL1 - SEQ ID NO: 105) CDRL1 (FRL2 - SEQ ID NO: 106) CDRL2EIVLTQSPATLSLSPGERATLSCXXXXXXXXXXWYQQKPGQAPRLLIYXXXXXXX       (FRL3 - SEQ ID NO: 107)   CDRL3   (FRL4 - SEQ ID NO: 108)GIPARFSGSGSGTDFILTISSLEPEDFAVYYCXXXXXXXXXFGGGTKVEIK

TABLE 12 Amino acid sequence of a human heavy chain framework regionVH3-7 with interspersed CDR sequences labeled     (FRH1 - SEQ ID NO: 109) CDRH1 (FRH2 - SEQ ID NO: 110)EVQLVESGGGLVQPGGSLRLSCAASXXXXXXXXXXWVRQAPGKGLEWVA       CDRH2               (FRH3 - SEQ ID NO: 111)XXXXXXXXXXXXXXXXXRFTISRDNAKNSLYLQMNSLRAEDTAVYYCAR   CDRH3  (FRH4 - SEQ ID NO: 112) XXXXXXXXXXWGQGTTVTVSS

TABLE 13 CDR Sequences SEQ ID NO:  CDR AA Sequence* 132 CDRL1 S X ₁ X ₂X ₃ X ₄ V X ₅ YMY 133 CDRL2 D X ₆ S X ₇ L X ₈ S 134 CDRL3 X ₉ X ₁₀WSGYPYT 135 CDRH1 GF X ₁₁ X ₁₂ S X ₁₃ FA X ₁₄ S 136 CDRH2 K X ₁₅ S X ₁₆GGS X ₁₇ X ₁₈ Y X ₁₉ X ₂₀ DT X ₂₁ X ₂₂ X ₂₃ 137 CDRH3 QLWG X ₂₄ YALD X₂₅ *X denotes any suitable amino acid with exemplary, non-limiting aminoacid substitutions shown in the sequences disclosed in SEQ ID NOS: 1-92of Tables 1 and 2 and in Tables 3, 4, 5A, and 8. In addition, X can havethe following values: X₁ = A or G X₂ = S or R X₃ = H, I, S, or Y X₄ = Sor Y X₅ = S or F X₆ = F, L, M, or T X₇ = N or E X₈ = A or T X₉ = M, C,or S X₁₀ = Q or C X₁₁ = T or Q X₁₂ = F, S, or T X₁₃ = S or P X₁₄ = L orM X₁₅ = A or I X₁₆ = S or P X₁₇ = Y or W X₁₈ = T, E, or Y X₁₉ = Y or FX₂₀ = P, S, D, or F X₂₁ = V or D X₂₂ = T or A X₂₃ = G or P X₂₄ = S, Y,T, or N X₂₅ = Y, T, F, or I

SEQ ID NO: 115 AMINO ACID SEQUENCE OF IL-6 PROTEINMNSFSTSAFGPVAFSLGLLLVLPAAFPAPVPPGEDSKDVAAPHRQPLTSSERIDKQIRYILDGISALRKETCNKSNMCESSKEALAENNLNLPKMAEKDGCFQSGFNEETCLVKIITGLLEFEVYLEYLQNRFESSEEQARAVQMSTKVLIQFLQKKAKNLDAITTPDPTTNASLLTKLQAQNQWLQDMTTHLILRSFKE FLQSSLRALRQM

What is claimed is:
 1. A method for suppressing rheumatoid arthritis inan animal, comprising: administering a composition comprising aneffective amount of an IL-6 antibody and a composition comprising aneffective amount of an antirheumatic to said animal, wherein the IL-6antibody comprises at least one light chain variable region and oneheavy chain variable region, said light chain variable regioncomprising: a complementarity determining region light chain 1 (CDRL1)amino acid sequence of SEQ ID NO:132 comprising the sequenceS-X₁-X₂-X₃-X₄-V-X₅-Y-M-Y, wherein X₁ is A or G, X₂ is S or R, X₃ is H,I, S, or Y, X₄ is S or Y, and X₅ is S or F; a CDRL2 amino acid sequenceof SEQ ID NO:133 comprising the sequence D-X₆-S-X₇-L-X₈-S, wherein X₆ isF, L, M, or T, X₇ is N or E, and X₈ is A or T; and a CDRL3 amino acidsequence of SEQ ID NO:134 comprising the sequence X₉-X₁₀-W-S-G-Y-P-Y-T,wherein X₉ is M, C, or S, and X₁₀ is Q or C; said heavy chain variableregion comprising: a complementarity determining region heavy chain 1(CDRH1) amino acid sequence of SEQ ID NO:135 comprising the sequenceG-F-X₁₁-X₁₂-S-X₁₃-F-A-X₁₄-S, wherein X₁₁ is T or Q, X₁₂ is F, S, or T,X₁₃ is S or P, and X₁₄ is L or M; a CDRH2 amino acid sequence of SEQ IDNO:136 comprising the sequenceK-X₁₅-S-X₁₆-G-G-S-X₁₇-X₁₈-Y-X₁₉-X₂₀-D-T-X₂₁-X₂₂-X₂₃, wherein X₁₅ is A orI, X₁₆ is S or P, X₁₇ is Y or W, X₁₈ is T, E, or Y, X₁₉ is Y or F, X₂₀is P, S, D, or F, X₂₁ is V or D, X₂₂ is T or A, and X₂₃ is G or P; and aCDRH3 amino acid sequence of SEQ ID NO:137 comprising the sequenceQ-L-W-G-X₂₄-Y-A-L-D-X₂₅, wherein X₂₄ is S, Y, T, or N, and X₂₅ is Y, T,F, or I.
 2. The method according to claim 1, wherein said effectiveamount of antibody is about 0.001-50 mg/kilogram of said animal.
 3. Themethod according to claim 1, wherein said administering is bysubcutaneous method.
 4. The method according to 1, wherein theantirheumatic is methotrexate and is administered, prior, concurrentlyor after administering the antibody.
 5. A method for suppressingrheumatoid arthritis in an animal, comprising: administering acomposition comprising an effective amount of an IL-6 antibody and acomposition comprising an effective amount of an antirheumatic to saidanimal, wherein the IL-6 antibody comprises a light chain variableregion amino acid sequence of SEQ ID NO:97 and a heavy chain variableregion amino acid sequence of SEQ ID NO:99.
 6. The method according toclaim 5, wherein said effective amount of antibody is about 0.001-50mg/kilogram of said animal.
 7. The method according to claim 5, whereinsaid administering is by subcutaneous method.
 8. The method according to5, wherein the antirheumatic is methotrexate and is administered, prior,concurrently or after administering the antibody.
 9. A method forsuppressing rheumatoid arthritis in an animal, comprising: administeringa composition comprising an effective amount of an IL-6 antibody and acomposition comprising an effective amount of an antirheumatic to saidanimal, wherein the IL-6 antibody comprises a complementaritydetermining region light chain 1 (CDRL1) amino acid sequence of SEQ IDNO:3, a CDRL2 amino acid sequence of SEQ ID NO:21, a CDRL3 amino acidsequence of SEQ ID NO:29, a complementarity determining region heavychain 1 (CDRH1) amino acid sequence of SEQ ID NO:39, a CDRH2 amino acidsequence of SEQ ID NO:59, and a CDRH3 amino acid sequence of SEQ IDNO:89.
 10. The method according to claim 9, wherein said effectiveamount of antibody is about 0.001-50 mg/kilogram of said animal.
 11. Themethod according to claim 9, wherein said administering is bysubcutaneous method.
 12. The method according to 9, wherein theantirheumatic is methotrexate and is administered, prior, concurrentlyor after administering the antibody.